title: Plasma and mucosal HIV viral loads are associated with genital tract inflammation in HIV-infected women.
abstract: BACKGROUND
  Systemic and mucosal inflammation may play a role in HIV control. A cross-sectional comparison was conducted among women in the Women's Interagency HIV Study to explore the hypothesis that compared with HIV-uninfected participants, women with HIV, and, in particular, those with high plasma viral load (PVL) have increased levels of mucosal and systemic inflammatory mediators and impaired mucosal endogenous antimicrobial activity.
  
  
  METHODS
  Nineteen HIV-uninfected, 40 HIV-infected on antiretroviral therapy (ART) with PVL ≤ 2600 copies/mL (low viral load) (HIV-LVL), and 19 HIV-infected on or off ART with PVL >10,000 (high viral load) (HIV-HVL) were evaluated. Immune mediators and viral RNA were quantified in plasma and cervicovaginal lavage (CVL). The CVL antimicrobial activity was also determined.
  
  
  RESULTS
  Compared to HIV-uninfected participants, HIV-HVL women had higher levels of mucosal but not systemic proinflammatory cytokines and chemokines, higher Nugent scores, and lower Escherichia coli bactericidal activity. In contrast, there were no significant differences between HIV-LVL and HIV-uninfected controls. After adjusting for PVL, HIV genital tract shedding was significantly associated with higher CVL concentrations of IL-6, IL-1β, MIP-1α, and CCL5 (RANTES) and higher plasma concentrations of MIP-1α. High PVL was associated with higher CVL levels of IL-1β and RANTES, as well as with higher Nugent scores, lower E. coli bactericidal activity, smoking, and lower CD4 counts; smoking and CD4 count retained statistical significance in a multivariate model.
  
  
  CONCLUSIONS
  Further study is needed to determine if the relationship between mucosal inflammation and PVL is causal and to determine if reducing mucosal inflammation is beneficial.
authors.affiliation: Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY 10461, USA. betsy.herold@einstein.yu.edu
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Herold
authors.forename: Marla J
authors.initials: MJ
authors.lastname: Keller
authors.forename: Qiuhu
authors.initials: Q
authors.lastname: Shi
authors.forename: Donald R
authors.initials: DR
authors.lastname: Hoover
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Carpenter
authors.forename: Ashley
authors.initials: A
authors.lastname: Huber
authors.forename: Urvi M
authors.initials: UM
authors.lastname: Parikh
authors.forename: Kathy J
authors.initials: KJ
authors.lastname: Agnew
authors.forename: Howard
authors.initials: H
authors.lastname: Minkoff
authors.forename: Christine
authors.initials: C
authors.lastname: Colie
authors.forename: Marek J
authors.initials: MJ
authors.lastname: Nowicki
authors.forename: Gypsyamber
authors.initials: G
authors.lastname: DʼSouza
authors.forename: D Heather
authors.initials: DH
authors.lastname: Watts
authors.forename: Kathryn
authors.initials: K
authors.lastname: Anastos
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D002584:Cervix Uteri; D018925:Chemokines / Q000378:metabolism; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood / Q000378:metabolism*; D004926:Escherichia coli / Q000254:growth & development; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000276:immunology / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D009092:Mucous Membrane / Q000378:metabolism / Q000821:virology; D012367:RNA, Viral / Q000097:blood; D002575:Uterine Cervicitis / Q000378:metabolism* / Q000821:virology; D014621:Vagina; D044364:Vaginal Douching; D014627:Vaginitis / Q000378:metabolism* / Q000821:virology; D019562:Viral Load; D017201:Virus Shedding
chemical_list: D044966:Anti-Retroviral Agents; D018925:Chemokines; D016207:Cytokines; D012367:RNA, Viral