Vaginal Cytomegalovirus Shedding Before and After Initiation of Antiretroviral Therapy in Rakai, Uganda.
Vaginal shedding of cytomegalovirus (CMV) DNA was determined longitudinally among 96 women coinfected with human immunodeficiency virus (HIV), herpes simplex virus 2, and CMV starting antiretroviral therapy (ART) during a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Vaginal CMV was detected in 75 of 96 women (78.0%) and 379 of 1080 individual visits (35.1%). ART status, higher HIV RNA viral load before ART initiation, and younger age were significantly associated with increased frequency of CMV shedding (P < .01). Compared to pre-ART, CMV shedding peaked from month 2 to month 4 after ART initiation, suggesting possible immune reconstitution inflammatory syndrome. Further studies need to determine the clinical significance of asymptomatic CMV shedding.
Department of Infectious Disease, University of California San Diego, La Jolla.
Sara
S
Gianella
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Department of Medicine, School of Medicine, Johns Hopkins University.
Andrew D
AD
Redd
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health.
Mary K
MK
Grabowski
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
Aaron A R
AA
Tobian
Rakai Health Sciences Program, Entebbe Institute of Public Health, Makerere University, Kampala, Uganda.
David
D
Serwadda
Clinical Research Directorate/Clinical Monitoring Research Program, SAIC-Frederick, Inc, Frederick National Laboratory for Cancer Research, Maryland.
Kevin
K
Newell
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda.
Eshan U
EU
Patel
Rakai Health Sciences Program, Entebbe.
Sarah
S
Kalibbala
Rakai Health Sciences Program, Entebbe.
Paschal
P
Ssebbowa
Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health Rakai Health Sciences Program, Entebbe.
Ronald H
RH
Gray
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Department of Medicine, School of Medicine, Johns Hopkins University.
Thomas C
TC
Quinn
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda Department of Medicine, School of Medicine, Johns Hopkins University Rakai Health Sciences Program, Entebbe.
Steven J
SJ
Reynolds
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000453:epidemiology; D004311:Double-Blind Method; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D006558:Herpes Genitalis / Q000188:drug therapy; D018258:Herpesvirus 2, Human; D006801:Humans; D008137:Longitudinal Studies; D014454:Uganda / Q000453:epidemiology; D014621:Vagina / Q000821:virology*; D017201:Virus Shedding / Q000187:drug effects*
D044966:Anti-Retroviral Agents; D000212:Acyclovir
Uganda; acyclovir; antiretroviral therapy (ART); cytomegalovirus (CMV); human immunodeficiency virus (HIV); immune reconstitution inflammatory syndrome (IRIS); reactivation