title: Association of cervical biopsy with HIV type 1 genital shedding among women on highly active antiretroviral therapy.
abstract: HIV-1 genital shedding is associated with increased HIV-1 transmission risk. Inflammation and ulceration are associated with increased shedding, while highly active antiretroviral therapy (HAART) has been shown to have a protective effect. We sought to examine the impact of cervical biopsies, a routine component of cervical cancer screening, on HIV-1 genital RNA levels in HIV-infected women on HAART. We enrolled HIV-1-infected women undergoing cervical biopsy for diagnosis of cervical intraepithelial neoplasia (CIN) 2/3 in this prospective cohort study. All were stable on HAART for at least 3 months. Clinical and demographic information as well as plasma HIV-1 viral load were collected at the baseline visit. Specimens for cervical HIV-1 RNA were collected immediately prior to biopsy, and 2 and 7 days afterward. Quantitative PCR determined HIV-1 concentration in cervical specimens at each time point to a lower limit of detection of 40 copies/specimen. Among the 30 participants, five (16.6%) women had detectable cervical HIV-1 RNA at baseline, of whom four (80%) had detectable HIV-1 RNA after cervical biopsy, with no significant increase in viral load in the follow-up specimens. Only one woman (3.3%) with undetectable baseline cervical HIV-1 RNA had detection postbiopsy. Detectable plasma HIV-1 RNA was the only factor associated with baseline cervical HIV-1 RNA. In women on HAART, an increase in cervical HIV-1 RNA detection or concentration was not associated with cervical biopsy. These findings help provide safety data regarding cervical cancer screening and diagnosis in HIV-infected women and inform postprocedure counseling.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Victoria G
authors.initials: VG
authors.lastname: Woo
authors.forename: Teri
authors.initials: T
authors.lastname: Liegler
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: George F
authors.initials: GF
authors.lastname: Sawaya
authors.forename: Karen
authors.initials: K
authors.lastname: Smith-McCune
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Huchko
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001706:Biopsy / Q000009:adverse effects; D002584:Cervix Uteri / Q000821:virology*; D015331:Cohort Studies; D003127:Colposcopy / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D008403:Mass Screening / Q000009:adverse effects; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis
chemical_list: D012367:RNA, Viral