title: Changes in HIV-1 subtypes B and C genital tract RNA in women and men after initiation of antiretroviral therapy.
abstract: BACKGROUND
  Combination antiretroviral therapy (cART) reduces genital tract human immunodeficiency virus type 1 (HIV-1) load and reduces the risk of sexual transmission, but little is known about the efficacy of cART for decreasing genital tract viral load (GTVL) and differences in sex or HIV-1 subtype.
  
  
  METHODS
  HIV-1 RNA from blood plasma, seminal plasma, or cervical wicks was quantified at baseline and at weeks 48 and 96 after entry in a randomized clinical trial of 3 cART regimens.
  
  
  RESULTS
  One hundred fifty-eight men and 170 women from 7 countries were studied (men: 55% subtype B and 45% subtype C; women: 24% subtype B and 76% subtype C). Despite similar baseline CD4(+) cell counts and blood plasma viral loads, women with subtype C had the highest GTVL (median, 5.1 log10 copies/mL) compared to women with subtype B and men with subtype C or B (4.0, 4.0, and 3.8 log10 copies/mL, respectively; P < .001). The proportion of participants with a GTVL below the lower limit of quantification (LLQ) at week 48 (90%) and week 96 (90%) was increased compared to baseline (16%; P < .001 at both times). Women were significantly less likely to have GTVL below the LLQ compared to men (84% vs 94% at week 48, P = .006; 84% vs 97% at week 96, P = .002), despite a more sensitive assay for seminal plasma than for cervical wicks. No difference in GTVL response across the 3 cART regimens was detected.
  
  
  CONCLUSIONS
  The female genital tract may serve as a reservoir of persistent HIV-1 replication during cART and affect the use of cART to prevent sexual and perinatal transmission of HIV-1.
authors.affiliation: Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 709 Mary Ellen Jones Bldg, CB7209, Chapel Hill, NC 27599-7209, USA. fiscussa@med.unc.edu
authors.forename: Susan A
authors.initials: SA
authors.lastname: Fiscus
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
authors.forename: Abel Tilahun
authors.initials: AT
authors.lastname: Eshete
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hughes
authors.forename: Yajing
authors.initials: Y
authors.lastname: Bao
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Beatriz
authors.initials: B
authors.lastname: Grinsztejn
authors.forename: Sharlaa
authors.initials: S
authors.lastname: Badal-Faesen
authors.forename: Joan
authors.initials: J
authors.lastname: Dragavon
authors.forename: Robert W
authors.initials: RW
authors.lastname: Coombs
authors.forename: Ken
authors.initials: K
authors.lastname: Braun
authors.forename: Laura
authors.initials: L
authors.lastname: Moran
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.forename: Timothy
authors.initials: T
authors.lastname: Flanigan
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Campbell
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D005837:Genitalia, Male / Q000821:virology*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D010949:Plasma / Q000821:virology; D012367:RNA, Viral / Q000235:genetics / Q000302:isolation & purification; D019562:Viral Load
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral
keywords: HIV-1 genital tract RNA; HIV-1 subtypes B and C; antiretroviral drugs