title: Effect of acquisition and treatment of cervical infections on HIV-1 shedding in women on antiretroviral therapy.
abstract: 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.
authors.affiliation: Department of Medical Microbiology, University of Nairobi, Kenya. rgitau@africaonline.co.ke
authors.forename: Ruth W
authors.initials: RW
authors.lastname: Gitau
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Linnet N
authors.initials: LN
authors.lastname: Masese
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.forename: Vrasha
authors.initials: V
authors.lastname: Chohan
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Jeckoniah O
authors.initials: JO
authors.lastname: Ndinya-Achola
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
mesh_terms: 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
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral