title: HIV shedding in cervico-vaginal secretions in pregnant women.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the presence of HIV-1 in cervico-vaginal secretions of pregnant as compared to non-pregnant HIV-seropositive women.
  
  
  METHODS
  We compared 43 known HIV seropositive pregnant patients versus 241 age-matched (± 2 years) control non-pregnant HIV-seropositive subjects. In pregnant patients blood and cervico-vaginal samples were obtained during each trimester of pregnancy. In control subjects the same samples were obtained at enrolment. HIV-1 RNA was measured in plasma; proviral HIV-1 DNA, cell-associated and cell-free HIV-1 RNA in cervico-vaginal secretion by competitive polymerase chain reaction (cRT-PCR) and reverse transcriptase PCR.
  
  
  RESULTS
  The genital shedding of HIV-DNA (22/43 as compared to 79/241, p = 0.02), and cell-free HIV-RNA detection (26/43 as compared to 72/241, p < .001) was more common in first-trimester pregnant than in non pregnant women. Pregnancy correlated with a significant positive trend in the cervico-vaginal load of HIV-DNA (Spearman Rho= 0.149, p= 0.012), and cell-free HIV-RNA (Spearman Rho= 0.253, p < .001), but not of HIV-RNA transcripts (Spearman Rho = 0.06, p= 0.31). After correction for potential confounders, first trimester pregnant women had increased rates of genital HIV- DNA (odds ratio = 1.94, 95% confidence interval = 1.01 3.78) and cell-free HIV-RNA (odds ratio = 4.07, 95% confidence interval = 1.97 8.41) detection compared to nonpregnant controls.
  
  
  CONCLUSIONS
  The shedding of genital HIV was increased in pregnant compared to non pregnant subjects, even in patients with undetectable viremia. In this low-risk HIV-positive population the risks of vertical or horizontal transmissions should not be underestimated.
authors.affiliation: Department of Obstetrics and Gynecology, Fondazione IRCCS Policlinico San Matteo Pavia, Italy. barbara.gardella@gmail.com
authors.forename: Barbara
authors.initials: B
authors.lastname: Gardella
authors.forename: Marianna
authors.initials: M
authors.lastname: Roccio
authors.forename: Anna
authors.initials: A
authors.lastname: Maccabruni
authors.forename: Bianca
authors.initials: B
authors.lastname: Mariani
authors.forename: Lucia
authors.initials: L
authors.lastname: Panzeri
authors.forename: Francesca
authors.initials: F
authors.lastname: Zara
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000378:metabolism / Q000821:virology; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D015658:HIV Infections / Q000821:virology; D006679:HIV Seropositivity / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D006801:Humans; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D012367:RNA, Viral / Q000032:analysis* / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction / Q000379:methods; D014621:Vagina / Q000378:metabolism / Q000821:virology*; D017201:Virus Shedding
chemical_list: D004279:DNA, Viral; D012367:RNA, Viral