title: Genital ulceration does not increase HIV-1 shedding in cervical or vaginal secretions of women taking antiretroviral therapy.
abstract: OBJECTIVE
  Genital ulcer disease (GUD) is associated with increased HIV-1-RNA shedding in antiretroviral therapy (ART)-naive women. The effect of GUD on HIV-1 shedding among ART-treated women is not known. The objective of this study was to test the hypothesis that genital ulcerations increase genital HIV-1-RNA shedding in women receiving ART.
  
  
  METHODS
  Eligible women initiated ART and attended monthly visits with inspection for genital lesions and collection of genital swabs. GUD cases diagnosed after 2 months or more on ART were included for analysis and served as their own controls. HIV-1 RNA was quantitated in specimens collected before, during and after GUD for all cases. The lower limit of quantitation was 100 HIV-1-RNA copies/swab. Using the pre-GUD visit as the reference, the detection of genital HIV-1 RNA before versus during and after GUD episodes was compared.
  
  
  RESULTS
  36 women had GUD episodes after ART initiation. HIV-1 RNA was detected before, during and after GUD in cervical secretions from four (11%), one (3%) and six (17%) women, respectively, and in vaginal secretions from three (8%), four (11%) and four (11%) women, respectively. After adjustment for time on ART, there was no difference in the detection of cervical HIV-1 RNA before versus during GUD (adjusted OR 0.22, 95% CI 0.04 to 1.23). Likewise, GUD did not increase HIV-1 detection in vaginal secretions (adjusted OR 1.32, 95% CI 0.29 to 5.92).
  
  
  CONCLUSIONS
  GUD did not significantly increase cervical or vaginal HIV-1 shedding. The results suggest that ART maintains its effectiveness for genital HIV-1 suppression despite GUD episodes.
authors.affiliation: University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104-2499, USA. grahamsm@u.washington.edu
authors.forename: Susan M
authors.initials: SM
authors.lastname: Graham
authors.forename: Linnet
authors.initials: L
authors.lastname: Masese
authors.forename: Ruth
authors.initials: R
authors.lastname: Gitau
authors.forename: Barbra A
authors.initials: BA
authors.lastname: Richardson
authors.forename: Kishor
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Norbert
authors.initials: N
authors.lastname: Peshu
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Jeckoniah
authors.initials: J
authors.lastname: Ndinya-Achola
authors.forename: Julie
authors.initials: J
authors.lastname: Overbaugh
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClelland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002584:Cervix Uteri / Q000378:metabolism / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1; D006801:Humans; D009093:Mucus / Q000821:virology; D011446:Prospective Studies; D012367:RNA, Viral / Q000032:analysis; D014456:Ulcer / Q000821:virology*; D002577:Uterine Cervical Diseases / Q000821:virology*; D014621:Vagina / Q000378:metabolism / Q000821:virology; D014623:Vaginal Diseases / Q000821:virology*; D017201:Virus Shedding
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral