title: Infectious correlates of HIV-1 shedding in the female upper and lower genital tracts.
abstract: OBJECTIVE
  To determine the effects of vaginal, cervical, and endometrial infections on shedding of HIV-1 RNA in the female genital tract.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Antiretroviral-naive women from Nairobi, Kenya with CD4 cell counts >or= 350 cells/mul had plasma and endocervical wick samples collected for HIV quantification by real-time RNA reverse transcriptase-polymerase chain reaction. Vaginal and cervical Gram stains and endometrial biopsies were obtained. Vaginal Gram stain was used to diagnose bacterial vaginosis and to quantify Lactobacillus levels.
  
  
  RESULTS
  Twenty-six of 50 (52%) women had detectable endocervical HIV-1 RNA with a median endocervical viral load of 1760 copies/ml (range: undetectable to 1 1,030,000 copies/ml). Women with decreased Lactobacillus had 15.8-fold [95% confidence interval (CI), 2.0-123] greater endocervical HIV-1 RNA than women with normal Lactobacillus levels. Women with plasma cell (PC) endometritis [>or= 1 PC/high-power field (hpf)] had a 15.8-fold (95% CI, 2.0-120) higher endocervical HIV RNA level than women without PC endometritis. Both these associations remained after controlling for plasma viral load. Cervicitis (>or= 30 polymorphonuclear leukocytes/hpf), however, was not associated with endocervical HIV-1 RNA shedding (P = 0.81).
  
  
  CONCLUSIONS
  In HIV-1-infected, antiretroviral-naive women without symptoms of pelvic inflammatory disease infection, abnormal vaginal flora and inflammatory cells in the endometrium affected HIV-1 shedding from the lower genital tract. These data suggest that both the upper and lower genital tracts contribute to female HIV-1 genital shedding.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94105, USA.
authors.forename: Jenell S
authors.initials: JS
authors.lastname: Coleman
authors.forename: Jane
authors.initials: J
authors.lastname: Hitti
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Christina
authors.initials: C
authors.lastname: Mwachari
authors.forename: Angela
authors.initials: A
authors.lastname: Muliro
authors.forename: Rosemary
authors.initials: R
authors.lastname: Nguti
authors.forename: Reggie
authors.initials: R
authors.lastname: Gausman
authors.forename: Sarah
authors.initials: S
authors.lastname: Jensen
authors.forename: Dorothy
authors.initials: D
authors.lastname: Patton
authors.forename: David
authors.initials: D
authors.lastname: Lockhart
authors.forename: Robert
authors.initials: R
authors.lastname: Coombs
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D018592:Cross-Over Studies; D004716:Endometritis / Q000821:virology; D005260:Female; D005831:Genital Diseases, Female / Q000382:microbiology* / Q000821:virology; D005836:Genitalia, Female / Q000382:microbiology* / Q000821:virology; D015658:HIV Infections / Q000276:immunology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood; D019562:Viral Load; D017201:Virus Shedding / Q000502:physiology
chemical_list: D012367:RNA, Viral