title: Genital tract inflammation during early HIV-1 infection predicts higher plasma viral load set point in women.
abstract: BACKGROUND
  The biggest challenge in human immunodeficiency virus type 1 (HIV-1) prevention in Africa is the high HIV-1 burden in young women. In macaques, proinflammatory cytokine production in the genital tract is necessary for target cell recruitment and establishment of simian immunodeficiency virus (SIV) infection following vaginal inoculation. The purpose of this study was to assess if genital inflammation during early HIV-1 infection predisposes women to rapid disease progression.
  
  
  METHODS
  Inflammatory cytokine concentrations were measured in cervicovaginal lavage (CVL) from 49 women 6, 17, 30, and 55 weeks after HIV-1 infection and from 22 of these women before infection. Associations between genital inflammation and viral load set point and blood CD4 cell counts 12 months after infection were investigated.
  
  
  RESULTS
  Elevated genital cytokine concentrations 6 and 17 weeks after HIV-1 infection were associated with higher viral load set points and, to a lesser extent, with CD4 depletion. CVL cytokine concentrations during early infection did not differ relative to preinfection but were elevated in women who had vaginal discharge, detectable HIV-1 RNA in their genital tracts, and lower blood CD4 counts.
  
  
  CONCLUSIONS
  Genital inflammation during early HIV-1 infection was associated with higher viral load set point and CD4 depletion, which are markers of rapid disease progression. Strategies aimed at reducing genital inflammation during early HIV-1 infection may slow disease progression.
authors.affiliation: Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School, Observatory, 7925 Cape Town, South Africa.
authors.forename: Lindi
authors.initials: L
authors.lastname: Roberts
authors.forename: Jo-Ann S
authors.initials: JA
authors.lastname: Passmore
authors.forename: Koleka
authors.initials: K
authors.lastname: Mlisana
authors.forename: Carolyn
authors.initials: C
authors.lastname: Williamson
authors.forename: Francesca
authors.initials: F
authors.lastname: Little
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bebell
authors.forename: Gerhard
authors.initials: G
authors.lastname: Walzl
authors.forename: Melissa-Rose
authors.initials: MR
authors.lastname: Abrahams
authors.forename: Zenda
authors.initials: Z
authors.lastname: Woodman
authors.forename: Quarraisha
authors.initials: Q
authors.lastname: Abdool Karim
authors.forename: Salim S
authors.initials: SS
authors.lastname: Abdool Karim
mesh_terms: D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D016207:Cytokines / Q000378:metabolism*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000821:virology*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D012367:RNA, Viral / Q000378:metabolism*; D018709:Statistics, Nonparametric; D013997:Time Factors; D002575:Uterine Cervicitis / Q000150:complications / Q000378:metabolism* / Q000821:virology; D044364:Vaginal Douching; D014627:Vaginitis / Q000150:complications / Q000378:metabolism* / Q000821:virology; D019562:Viral Load; D055815:Young Adult
chemical_list: D016207:Cytokines; D012367:RNA, Viral