Association between paired plasma and cervicovaginal lavage fluid HIV-1 RNA levels during 36 months.
OBJECTIVE
To determine the patterns and predictors of genital tract HIV-1 RNA levels during a 36-month period.


METHODS
HIV-1 RNA levels were measured blood in plasma and the genital tract (by cervicovaginal lavage [CVL]) at baseline before highly, active antiretroviral therapy, at 2 and 4 weeks and every 6 months. Viral loads were measured using nucleic acid sequence-based amplification assay with a lower limit of detection of 2.6 log10 copies/mL.


RESULTS
Ninety-seven women had a median of 30.4 months' follow-up, with 530 paired PVL and CVL specimens. The strongest predictor of CVL fluid HIV-1 RNA detection was PVL of more than 2.6 log10 copies/mL, with an odds ratio of 13.7 (P < 0.0001). Each log10 unit increase in PVL increased the odds of detecting HIV-1 RNA in CVL fluid by 2.6 folds (P = 0.0002). Cervicovaginal lavage fluid HIV-1 RNA exceeded PVL on 5% of visits. When patients achieved undetectable levels of HIV-1 RNA in both plasma and CVL fluid, rebound of HIV-1 RNA occurred in plasma first or concurrently with CVL fluid HIV-1 RNA.


CONCLUSIONS
Plasma viral load is the strongest predictor of CVL fluid HIV-1 RNA detection. Cervicovaginal lavage fluid HIV-1 RNA levels are generally lower than PVL. Plasma viral load is more likely to rebound first or at the same time as CVL fluid viral load.
Cu-Uvin
Susan
S
The Miriam Hospital, Brown Medical School, Providence, Rhode Island, USA. scu-uvin@lifespan.org
Snyder
Brad
B
Harwell
Joseph I
JI
Hogan
Joseph
J
Chibwesha
Carla
C
Hanley
Dawn
D
Ingersoll
Jessica
J
Kurpewski
Jaclynn
J
Mayer
Kenneth H
KH
Caliendo
Angela M
AM
D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D013223:Statistics as Topic; D014621:Vagina / Q000821:virology*; D044364:Vaginal Douching; D019562:Viral Load; D014766:Viremia
D012367:RNA, Viral