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.
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.
McClelland
R Scott
RS
Departments of Medicine, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104, USA. mcclell@u.washington.edu
Baeten
Jared M
JM
Richardson
Barbra A
BA
Lavreys
Ludo
L
Emery
Sandra
S
Mandaliya
Kishorchandra
K
Ndinya-Achola
Jeckoniah O
JO
Overbaugh
Julie
J
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
D004279:DNA, Viral; D012367:RNA, Viral