Effect of acquisition and treatment of cervical infections on HIV-1 shedding in women on antiretroviral therapy

aDepartment of Medical Microbiology, University of Nairobi, Nairobi, Kenya bDepartment of Medicine, University of Washington, Seattle, Washington, USA cKenya Medical Research Institute, Kilifi, Kenya dDepartment of Epidemiology, USA eDepartment of Biostatistics, USA fDepartment of Global Health, University of Washington, USA gDivision of Human Biology, USA hDivision of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

Cervicitis increases the quantity of HIV-1 RNA in cervical secretions when women are not taking antiretroviral therapy (ART), and successful treatment of cervicitis reduces HIV-1 shedding in this setting.

To determine the effect of acquisition and treatment of cervical infections on genital HIV-1 shedding in women receiving ART.

Prospective cohort study.

We followed 147 women on ART monthly for incident nonspecific cervicitis, gonorrhea, and chlamydia. Cervical swabs for HIV-1 RNA quantitation were collected at every visit. The lower limit for linear quantitation was 100 copies per swab. We compared the prevalence of HIV-1 RNA detection before (baseline) versus during and after treatment of cervical infections.

Thirty women contributed a total of 31 successfully treated episodes of nonspecific cervicitis (N = 13), gonorrhea (N = 17), and chlamydia (N = 1). HIV-1 RNA was detected in cervical secretions before, during, and after cervicitis at one (3.2%), five (16.1%), and three (9.7%) visits, respectively. Compared with baseline, detection of HIV-1 RNA was increased when cervical infections were present (adjusted odds ratio 5.7, 95% confidence interval 1.0-30.3, P = 0.04). However, even in the subset of women with cervical HIV-1 RNA levels above the threshold for quantitation, most had low concentrations during cervical infections (median 115, range 100-820 copies per swab).

Although these data show a statistically significant increase in cervical HIV-1 RNA detection when cervical infections are present, most cervical HIV-1 RNA concentrations were near the threshold for detection, suggesting that infectivity remains low. Antiretroviral therapy appears to limit increases in genital HIV-1 shedding caused by cervical infections.
25 October 2010
Translation / Edition: Admin