title: Persistent genital tract HIV-1 RNA shedding after change in treatment regimens in antiretroviral-experienced women with detectable plasma viral load.
abstract: OBJECTIVE
  To longitudinally assess the association between plasma viral load (PVL) and genital tract human immunodeficiency virus (GT HIV) RNA among HIV-1 infected women changing highly active antiretroviral therapy (HAART) because of detectable PVL on current treatment.
  
  
  METHODS
  Women were eligible for the study if they had detectable PVL (defined as two consecutive samples with PVL>1000 copies/mL) and intended to change their current HAART regimen at the time of enrollment. Paired plasma and GT HIV-1 RNA were measured prospectively over 3 years. Longitudinal analyses examined rates of GT HIV-1 RNA shedding and the association with PVL.
  
  
  RESULTS
  Sixteen women were followed for a median of 11 visits contributing a total of 205 study visits. At study enrollment, all had detectable PVL and 69% had detectable GT HIV-1 RNA. Half of the women changed to a new HAART regimen with ≥3 active antiretroviral drugs. The probability of having detectable PVL ≥30 days after changing HAART was 0.56 (95% CI: 0.37 to 0.74). Fourteen women (88%) had detectable PVL on a follow-up visit ≥30 or 60 days after changing HAART; and 12 women (75%) had detectable GT HIV-1 RNA on a follow-up visit ≥30 or 60 days after changing HAART. When PVL was undetectable, GT shedding occurred at 11% of visits, and when PVL was detectable, GT shedding occurred at 47% of visits.
  
  
  CONCLUSIONS
  Some treatment-experienced HIV-infected women continue to have detectable virus in both the plasma and GT following a change in HAART, highlighting the difficulty of viral suppression in this patient population.
authors.affiliation: Department of Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, Alpert Medical School, Brown University, Providence, RI, USA. Kartik_Venkatesh@Brown.edu
authors.forename: Kartik K
authors.initials: KK
authors.lastname: Venkatesh
authors.forename: Allison K
authors.initials: AK
authors.lastname: DeLong
authors.forename: Rami
authors.initials: R
authors.lastname: Kantor
authors.forename: Stacey
authors.initials: S
authors.lastname: Chapman
authors.forename: Jessica
authors.initials: J
authors.lastname: Ingersoll
authors.forename: Jaclynn
authors.initials: J
authors.lastname: Kurpewski
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: De Pasquale
authors.forename: Richard
authors.initials: R
authors.lastname: D'Aquila
authors.forename: Angela M
authors.initials: AM
authors.lastname: Caliendo
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D015658:HIV Infections / Q000188:drug therapy / Q000503:physiopathology* / Q000821:virology; D015497:HIV-1; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012367:RNA, Viral / Q000032:analysis; D019562:Viral Load / Q000187:drug effects; D017201:Virus Shedding / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral