Genital tract leukocytes and shedding of genital HIV type 1 RNA.
BACKGROUND
The mechanism of human immunodeficiency virus (HIV) transmission via heterosexual intercourse is unknown. We sought to determine whether the presence of inflammatory cells in the vagina is associated with the presence of genital tract HIV type 1 (HIV-1) RNA.


METHODS
Analysis of a longitudinal prospective cohort was performed. Women with HIV-1 infection were assessed with use of paired plasma and cervicovaginal lavage specimens. Viral load measurements were performed using nucleic acid sequence-based amplification. White blood cells found in the genital tract (GT WBCs) were quantified using a hemacytometer. Common lower genital tract infections assessed for association with viral shedding (i.e., genital tract viral load [GTVL]) included bacterial vaginosis, candidiasis, and trichomoniasis. Generalized estimating equations were used to estimate the prevalence and odds of detectable GTVL by GT WBC. The association was examined both in the presence and in the absence of lower genital tract infections.


RESULTS
A total of 97 women and 642 visits were included in the analysis. Median duration of follow-up was 30.4 months. Thirty women (31%) had detectable GTVL at any visit. The median CD4 cell count at baseline was 525 cells/muL. Most women were antiretroviral therapy naive at baseline. After adjustment for plasma viral load, the odds of detectable GTVL increased as GT WBC increased, with an odds ratio of 1.36 (95% confidence interval, 1.1-1.7) per 1000-cell increase in GT WBC among women without lower genital tract infections. After adjustment for plasma viral load and lower genital tract infections by incorporating them in a regression model, GT WBC remained significantly associated with GTVL, with an adjusted odds ratio of 1.22 (95% confidence interval, 1.08-1.37).


CONCLUSIONS
The presence of GT WBC is associated with an increased risk of detectable GTVL.
Anderson
Brenna L
BL
Department of Obstetrics and Gynecology, Women & Infants' Hospital, Providence, RI 02905, USA. banderson@wihri.org
Wang
Chia-Ching
CC
Delong
Allison K
AK
Liu
Tao
T
Kojic
Erna Milu
EM
Kurpewski
Jaclynn
J
Ingersoll
Jessica
J
Mayer
Kenneth
K
Caliendo
Angela M
AM
Cu-Uvin
Susan
S
D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics* / Q000302:isolation & purification*; D006801:Humans; D007962:Leukocytes / Q000821:virology*; D008875:Middle Aged; D011446:Prospective Studies; D012367:RNA, Viral / Q000235:genetics* / Q000302:isolation & purification*; D054063:Superior Sagittal Sinus; D014621:Vagina / Q000821:virology*
D012367:RNA, Viral