Plasma and cervical viral loads among Ugandan and Zimbabwean women during acute and early HIV-1 infection.
OBJECTIVE
High levels of HIV-1 viremia exist in peripheral blood during acute and early infection; however, data on HIV-1 viral loads in female genital secretions during this period are sparse.


METHODS
Prospective cohort of 188 African women with primary HIV-1 infection.


METHODS
HIV-uninfected and infected women were followed quarterly; we tested serial plasma specimens by HIV PCR to estimate infection dates. We used the Loess procedure to estimate the magnitude and timing of viral setpoints in plasma and cervical secretions and generalized estimating equations (GEE) to identify predictors of plasma and cervical viral setpoints.


RESULTS
We estimated the mean HIV-1 plasma setpoint to be 4.20 log10 HIV-1 RNA copies/ml [95% confidence interval (CI) 4.04-4.35] at 121 days (95% CI 91-137) from infection; an analogous mean cervical viral setpoint was 1.64 log10 HIV-1 RNA copies/swab (95% CI 1.46-1.82) at 174 days (95% CI 145-194) from infection. Cervical loads were significantly higher (0.7-1.1 log10 copies/swab) during acute infection than subsequently. Subtype D infection, pregnancy, breastfeeding, and older age at the time of infection were associated with higher plasma viral setpoint. Subtype C infection, nonviral sexually transmitted infections, having a partner spending nights away from home, recent unprotected sex, and shorter time since infection were associated with higher cervical HIV-1 loads. Hormonal contraception was not associated with either the HIV-1 plasma setpoint or cervical loads during early infection.


CONCLUSIONS
Cervical HIV-1 viral loads were highest during acute infection and then declined up to 6 months following infection, when a 'setpoint' was attained. The prognostic value of a cervical 'setpoint' on future transmission risk remains unclear.
Behavioral and Biomedical Research Department, Family Health International, Research Triangle Park, NC 27709, USA. cmorrison@fhi.org
Charles S
CS
Morrison
Korey
K
Demers
Cynthia
C
Kwok
Stanley
S
Bulime
Anne
A
Rinaldi
Marshall
M
Munjoma
Megan
M
Dunbar
Tsungai
T
Chipato
Josaphat
J
Byamugisha
Barbara
B
Van Der Pol
Eric
E
Arts
Robert A
RA
Salata
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D004279:DNA, Viral; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D006679:HIV Seropositivity / Q000235:genetics / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D012367:RNA, Viral; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load; D014766:Viremia / Q000453:epidemiology / Q000821:virology*; D017201:Virus Shedding / Q000235:genetics / Q000276:immunology*; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
D004279:DNA, Viral; D012367:RNA, Viral