title: A comparison of genital HIV-1 shedding and sexual risk behavior among Kenyan women based on eligibility for initiation of HAART according to WHO guidelines.
abstract: BACKGROUND
  Guidelines for initiating antiretrovirals are based on markers of advanced disease and are not directly linked to markers of HIV-1 transmission such as viral shedding.
  
  
  METHODS
  We evaluated genital HIV-1 shedding and risk behavior among 650 antiretroviral-naïve women stratified by WHO criteria for initiating antiretrovirals based on CD4 count and symptoms.
  
  
  RESULTS
  Genital HIV-1 concentrations increased in stepwise fashion with declining CD4 counts and the presence of symptoms. Compared with the reference group (asymptomatic with CD4 >350 cells/microL), those with advanced immunosuppression (CD4 <200 cells/microL) had significantly higher cervical HIV-1 RNA concentrations (2.4 log10 copies/swab vs. 3.8 log10 copies/swab, P < 0.001). However, women with CD4 counts <200 cells/microL were also less likely than the reference group to report intercourse during the past week (58% vs. 26%, P < 0.001).
  
  
  CONCLUSIONS
  Antiretroviral guidelines focusing on individuals with the most advanced immunosuppression will target those with the highest genital HIV-1 concentrations. However, individuals with less advanced immunosuppression also have high levels of genital HIV-1 and may be more sexually active. The effect of increased antiretroviral availability on the spread of HIV-1 might be enhanced by extending treatment, in addition to other risk reduction services, to those with less advanced disease.
authors.affiliation: Departments of Medicine, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104, USA. mcclell@u.washington.edu
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Ludo
authors.initials: L
authors.lastname: Lavreys
authors.forename: Sandra
authors.initials: S
authors.lastname: Emery
authors.forename: Kishorchandra
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control / Q000635:transmission; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000821:virology*; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood / Q000302:isolation & purification; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007630:Kenya; D017410:Practice Guidelines as Topic; D012367:RNA, Viral / Q000097:blood / Q000302:isolation & purification; D012309:Risk-Taking; D012725:Sexual Behavior; D014621:Vagina / Q000821:virology*; D019562:Viral Load; D017201:Virus Shedding; D014944:World Health Organization
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral