title: HIV-DNA in the genital tract of women on long-term effective therapy is associated to residual viremia and previous AIDS-defining illnesses.
abstract: OBJECTIVE
  To assess the impact of long-term combined antiretroviral therapy (cART) on HIV-RNA and HIV-DNA levels in cervicovaginal secretions of HIV-1-infected women with sustained undetectable plasma RNA viral load (PVL); to explore factors predictive of residual viral shedding; and to evaluate the risk of heterosexual transmission.
  
  
  METHODS
  Women with undetectable PVL (<50 copies/mL) for >6 months were included in this cross-sectional study. HIV-RNA and HIV-DNA were measured in blood and cervicovaginal lavage fluid (CVL). Women were systematically tested for genital infections. The risk of transmission to male partners during unprotected intercourse was estimated.
  
  
  RESULTS
  Eighty-one women composed the study population: all had HIV-RNA <40 copies/mL in CVL. HIV-DNA was detectable in CVL of 29/78 patients (37%). There was a weak positive correlation between HIV-DNA levels in PBMCs and CVL (r = 0.20; p = 0.08). In multivariate analysis, two factors were associated with HIV-DNA detection in CVL: previous AIDS-defining illnesses (OR = 11; 95%CI = 2-61) and current residual viremia (20<PVL<50 cp/mL) (OR = 3.4; 95%CI = 1.1-10.9). Neither the classes of cART regimen nor the presence of genital bacterial or fungal colonization were associated with HIV-DNA detection in CVL. Twenty-eight percent of the women had unprotected intercourse with their regular HIV-seronegative male partner, for between 8 and 158 months. None of their male partners became infected, after a total of 14 000 exposures.
  
  
  CONCLUSIONS
  In our experience, HIV-RNA was undetectable in the genital tract of women with sustained control of PVL on cART. HIV-DNA shedding persisted in about one third of cases, with no substantial evidence of residual infectiousness.
authors.affiliation: Department of Infectious Diseases, CHR d'Orléans-La Source, Orléans, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Prazuck
authors.forename: Antoine
authors.initials: A
authors.lastname: Chaillon
authors.forename: Véronique
authors.initials: V
authors.lastname: Avettand-Fènoël
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Caplan
authors.forename: Collins
authors.initials: C
authors.lastname: Sayang
authors.forename: Aurélie
authors.initials: A
authors.lastname: Guigon
authors.forename: Mohamadou
authors.initials: M
authors.lastname: Niang
authors.forename: Francis
authors.initials: F
authors.lastname: Barin
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.forename: Laurent
authors.initials: L
authors.lastname: Hocqueloux
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D012634:Bodily Secretions / Q000821:virology; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008875:Middle Aged; D012367:RNA, Viral / Q000302:isolation & purification; D012306:Risk; D014621:Vagina / Q000821:virology*; D019562:Viral Load; D014766:Viremia / Q000150:complications*; D017201:Virus Shedding
chemical_list: D044966:Anti-Retroviral Agents; D004279:DNA, Viral; D012367:RNA, Viral