Cervicovaginal HIV-1 shedding in women taking antiretroviral therapy in Burkina Faso: a longitudinal study.
BACKGROUND
Antiretroviral therapy (ART) reduces transmission of HIV-1. However, genital HIV-1 can be detected in patients on ART. We analyzed factors associated with genital HIV-1 shedding among high-risk women on ART in Burkina Faso.


METHODS
Plasma viral load (PVL) and enriched cervicovaginal lavage HIV-1 RNA were measured every 3-6 months for up to 8 years. Random-effects logistic and linear regression models were used to analyze associations of frequency and quantity of genital HIV-1 RNA with behavioral and biological factors, adjusting for within-woman correlation. The lower limit of detection of HIV-1 RNA in plasma and eCVL samples was 300 copies per milliliter.


RESULTS
One hundred and eighty-eight participants initiated ART from 2004 to 2011. PVL was detectable in 16% (171/1050) of visits, in 52% (90/174) of women. Cervicovaginal HIV-1 RNA was detectable in 16% (128/798) of visits with undetectable plasma HIV-1 RNA in 45% (77/170) of women. After adjusting for PVL, detectable cervicovaginal HIV-1 RNA was independently associated with abnormal vaginal discharge and use of nevirapine or zidovudine vs. efavirenz and stavudine, respectively; longer time on ART and hormonal contraception were not associated with increased shedding. The presence of bacterial vaginosis, herpes simplex virus-2 DNA, and the use of nevirapine vs efavirenz were independently associated with an increased quantity of cervicovaginal HIV-1 RNA.


CONCLUSIONS
Certain ART regimens, abnormal vaginal discharge, bacterial vaginosis, and genital herpes simplex virus-2 are associated with HIV-1 cervicovaginal shedding or quantity in women on ART after adjusting for PVL. This may reduce the effectiveness of ART as prevention in high-risk populations.
*Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; †Research Unit on Reproductive Health, and HIV, Centre Muraz, Bobo-Dioulasso, Burkina Faso; ‡Department of microbiology-virology, and medical research, INSERM U1058; the Departments of §Clinical Research and ‖Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; and ¶Department of Virology, University College London, London, United Kingdom.
Andrea J
AJ
Low
Issouf
I
Konate
Nicolas
N
Nagot
Helen A
HA
Weiss
Dramane
D
Kania
Peter
P
Vickerman
Michel
M
Segondy
David
D
Mabey
Deenan
D
Pillay
Nicolas
N
Meda
Philippe
P
van de Perre
Philippe
P
Mayaud
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002050:Burkina Faso; D015331:Cohort Studies; D005260:Female; D005836:Genitalia, Female / Q000821:virology*; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000821:virology; D012367:RNA, Viral / Q000097:blood / Q000302:isolation & purification; D012307:Risk Factors; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult
D012367:RNA, Viral