Cervicovaginal HIV-1 shedding in women taking antiretroviral therapy in Burkina Faso: a longitudinal study.

Abstract

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.

• Authors: Andrea J Low, Issouf Konate, Nicolas Nagot, Helen A Weiss, Dramane Kania, Peter Vickerman, Michel Segondy, David Mabey, Deenan Pillay, Nicolas Meda, Philippe van de Perre, Philippe Mayaud, Yerelon Study Group
• Journal: Journal of acquired immune deficiency syndromes (1999) (J Acquir Immune Defic Syndr) Vol. 65 Issue 2 Pg. 237-45 (Feb 01 2014) ISSN: 1944-7884 [Electronic] United States
• PMID: 24226060 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• RNA, Viral

Topics

• Adolescent
• Adult
• Antiretroviral Therapy, Highly Active (methods)
• Burkina Faso
• Cohort Studies
• Female
• Genitalia, Female (virology)
• HIV Infections (drug therapy, virology)
• HIV-1 (isolation & purification)
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Plasma (virology)
• RNA, Viral (blood, isolation & purification)
• Risk Factors
• Viral Load
• Virus Shedding
• Young Adult