Effect of acquisition and treatment of cervical infections on HIV-1 shedding in women on antiretroviral therapy.
BACKGROUND
Cervicitis increases the quantity of HIV-1 RNA in cervical secretions when women are not taking antiretroviral therapy (ART), and successful treatment of cervicitis reduces HIV-1 shedding in this setting.


OBJECTIVE
To determine the effect of acquisition and treatment of cervical infections on genital HIV-1 shedding in women receiving ART.


METHODS
Prospective cohort study.


METHODS
We followed 147 women on ART monthly for incident nonspecific cervicitis, gonorrhea, and chlamydia. Cervical swabs for HIV-1 RNA quantitation were collected at every visit. The lower limit for linear quantitation was 100 copies per swab. We compared the prevalence of HIV-1 RNA detection before (baseline) versus during and after treatment of cervical infections.


RESULTS
Thirty women contributed a total of 31 successfully treated episodes of nonspecific cervicitis (N = 13), gonorrhea (N = 17), and chlamydia (N = 1). HIV-1 RNA was detected in cervical secretions before, during, and after cervicitis at one (3.2%), five (16.1%), and three (9.7%) visits, respectively. Compared with baseline, detection of HIV-1 RNA was increased when cervical infections were present (adjusted odds ratio 5.7, 95% confidence interval 1.0-30.3, P = 0.04). However, even in the subset of women with cervical HIV-1 RNA levels above the threshold for quantitation, most had low concentrations during cervical infections (median 115, range 100-820 copies per swab).


CONCLUSIONS
Although these data show a statistically significant increase in cervical HIV-1 RNA detection when cervical infections are present, most cervical HIV-1 RNA concentrations were near the threshold for detection, suggesting that infectivity remains low. Antiretroviral therapy appears to limit increases in genital HIV-1 shedding caused by cervical infections.
Gitau
Ruth W
RW
Department of Medical Microbiology, University of Nairobi, Kenya. rgitau@africaonline.co.ke
Graham
Susan M
SM
Masese
Linnet N
LN
Overbaugh
Julie
J
Chohan
Vrasha
V
Peshu
Norbert
N
Richardson
Barbra A
BA
Jaoko
Walter
W
Ndinya-Achola
Jeckoniah O
JO
McClelland
R Scott
RS
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002584:Cervix Uteri / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D011446:Prospective Studies; D012367:RNA, Viral; D011795:Surveys and Questionnaires; D002575:Uterine Cervicitis / Q000188:drug therapy / Q000821:virology*; D017201:Virus Shedding
D004279:DNA, Viral; D012367:RNA, Viral