title: Cervical shedding of HIV-1 RNA among women with low levels of viremia while receiving highly active antiretroviral therapy.
abstract: BACKGROUND
  Among women with low or undetectable quantities of HIV-1 RNA in plasma, factors associated with genital HIV-1 RNA shedding, including choice of treatment regimen, are poorly characterized.
  
  
  METHODS
  We measured HIV-1 RNA in cervical swab specimens obtained from participants in the Women's Interagency HIV Study who had concurrent plasma viral RNA levels <500 copies/mL, and we assessed factors associated with genital HIV shedding. The study was powered to determine the relative effects of antiretroviral protease inhibitors (PIs) versus nonnucleoside reverse transcriptase inhibitors (NNRTIs) on viral RNA shedding.
  
  
  RESULTS
  Overall, 44 (15%) of 290 women had detectable HIV-1 RNA in cervical specimens. In the final multivariate model, shedding was independently associated with NNRTI (vs. PI) use (odds ratio [OR], 95% confidence interval [CI]: 2.24, 1.13 to 4.45) and illicit drug use (OR, 95% CI: 2.41, 0.96 to 5.69).
  
  
  CONCLUSIONS
  This is the largest study to define risks for genital HIV-1 RNA shedding in women with low/undetectable plasma virus. Shedding in this population was common, and NNRTI-based highly active antiretroviral therapy (HAART) (vs. PI-based HAART) was associated with genital HIV shedding. Further study is required to determine the impact of these findings on transmission of HIV from mother to child or to sexual partners.
authors.affiliation: Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. mneely@usc.edu
authors.forename: Michael N
authors.initials: MN
authors.lastname: Neely
authors.forename: Lorie
authors.initials: L
authors.lastname: Benning
authors.forename: Jiaao
authors.initials: J
authors.lastname: Xu
authors.forename: Howard D
authors.initials: HD
authors.lastname: Strickler
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Greenblatt
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Mary
authors.initials: M
authors.lastname: Young
authors.forename: James
authors.initials: J
authors.lastname: Bremer
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Levine
authors.forename: Andrea
authors.initials: A
authors.lastname: Kovacs
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002584:Cervix Uteri / Q000821:virology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D012367:RNA, Viral / Q000097:blood*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D014766:Viremia / Q000175:diagnosis / Q000503:physiopathology*; D017201:Virus Shedding
chemical_list: D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors