title: Correlates of human immunodeficiency virus cervicovaginal shedding among postmenopausal and fertile-aged women.
abstract: OBJECTIVE
  The aims of this study were to compare the intensity of human immunodeficiency virus (HIV)-RNA genital shedding among postmenopausal (PM) and fertile-aged (F) women and to investigate the association between viral shedding and gynecological features, HIV plasma viral loads, and other markers of HIV disease progression.
  
  
  METHODS
  We interviewed 146 HIV-infected women (73 PM/73 F) in search of gynecological complaints and signs and symptoms of HIV disease and obtained additional information concerning HIV infection by medical chart review. Cervicovaginal lavages (CVLs) were collected for assessment of HIV shedding. Laboratory analyses included CD4 cell counts, HIV-RNA quantitation in plasma and CVL, and screening for concurrent genital infections.
  
  
  RESULTS
  HIV-RNA genital shedding was detected in 16.4% of PM and 21.9% of F women (P = 0.400), and the intensity of HIV shedding did not differ between both groups (means-PM: 1.4log/mL; F: 1.4log/mL; P = 0.587). Three women (2 PM/1 F) exhibited viral shedding in the absence of detectable viremia. HIV plasma viral loads correlated with HIV shedding in both groups. In multivariable analysis, HIV plasma viral loads were independently associated with HIV shedding in both groups. Moreover, the intensity of shedding was independently associated with vaginal pH, tumor necrosis factor α concentrations in CVL, and HIV plasma viral loads.
  
  
  CONCLUSIONS
  Despite significant changes that occur in the vaginal mucosa of PM women, HIV cervicovaginal shedding was not significantly influenced by this state in our cohort. In contrast, increased vaginal pH and genital inflammation, evidenced by increased tumor necrosis factor α concentrations in CVL and HIV plasma viral loads, were independently associated with the intensity of HIV shedding in PM and F women.
authors: Virology Laboratory (LIM-52), Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil.
authors: Keli Cardoso
authors: KC
authors: Melo
authors: Murilo Rezende
authors: MR
authors: Melo
authors: Bruno Vita
authors: BV
authors: Ricci
authors: Aluisio Cotrim
authors: AC
authors: Segurado
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002584:Cervix Uteri / Q000821:virology*; D005260:Female; D005831:Genital Diseases, Female / Q000382:microbiology / Q000821:virology; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause; D012367:RNA, Viral / Q000032:analysis / Q000097:blood; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis; D014621:Vagina / Q000821:virology*; D019562:Viral Load; D014766:Viremia; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral; D014409:Tumor Necrosis Factor-alpha