Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma

Julie A.E. Nelson, Kristina De Paris, Catalina Ramirez, Andrew Edmonds, Katie R. Mollan, Camden P. Bay, Kara Compliment, Betsy C. Herold, Kathryn Anastos, Howard Minkoff, Seble Kassaye, Dominika L. Seidman, Audrey L. French, Elizabeth Golub, Anandi N. Sheth, Christina Ochsenbauer, Ronald Swanstrom, Joseph J. Eron, Adaora A. Adimora

Research output: Contribution to journalArticle

Abstract

Objective: Determine the frequency of genital HIV-1 shedding in a large cohort of women on longterm suppressive antiretroviral therapy (ART) and its association with mucosal inflammation. Design: We measured levels of HIV-1 RNA and inflammation biomarkers in cervicovaginal lavage (CVL) from HIV-seropositive women enrolled in the Women's Interagency HIV Study (WIHS). Methods: HIV-1 was quantified (Abbott RealTime HIV-1 assay) from CVL samples of 332 WIHS participants with and without clinical evidence of genital inflammation at the time of CVL collection; participants had suppressed plasma viral load (PVL) (limit of quantitation 20-4000 copies/ml depending on year of collection) for a median of 7.1 years (interquartile range=3.4-9.8, Group 1) or for a median of 1.0 years (IQR=0.5-1.0, Group 2). Twenty-two biomarkers of inflammation were measured in CVL to compare with clinical markers. Results: HIV-1 was detected in 47% of 38 pre-ART CVL samples (median 668 copies/ml) and detection in CVL was associated with higher pre-ART PVL. HIV-1 was detected in only 1 of 38 CVL samples from these women on suppressive antiretroviral therapy for one year. No HIV-1 RNA was detected in 294 CVL samples from a cross-sectional set of women with suppressed PVL for a median of 7 years. Clinical inflammation markers were correlated with inflammatory biomarkers in CVL specimens, although genital inflammation was not associated with measurable genital HIV-1 shedding in these WIHS participants on ART. Conclusions: ART that suppresses HIV-1 in the plasma of women also prevents genital tract HIV-1 shedding, even in the presence of genital tract inflammation.

Original languageEnglish (US)
JournalAIDS
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Therapeutic Irrigation
HIV-1
Inflammation
Biomarkers
Viral Load
HIV
Therapeutics
RNA

Keywords

  • cervicovaginal lavage
  • genital HIV-1 shedding
  • genital inflammation
  • inflammation biomarkers
  • suppressed
  • WIHS
  • women

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Nelson, J. A. E., De Paris, K., Ramirez, C., Edmonds, A., Mollan, K. R., Bay, C. P., ... Adimora, A. A. (Accepted/In press). Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma. AIDS. https://doi.org/10.1097/QAD.0000000000002373

Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma. / Nelson, Julie A.E.; De Paris, Kristina; Ramirez, Catalina; Edmonds, Andrew; Mollan, Katie R.; Bay, Camden P.; Compliment, Kara; Herold, Betsy C.; Anastos, Kathryn; Minkoff, Howard; Kassaye, Seble; Seidman, Dominika L.; French, Audrey L.; Golub, Elizabeth; Sheth, Anandi N.; Ochsenbauer, Christina; Swanstrom, Ronald; Eron, Joseph J.; Adimora, Adaora A.

In: AIDS, 01.01.2019.

Research output: Contribution to journalArticle

Nelson, JAE, De Paris, K, Ramirez, C, Edmonds, A, Mollan, KR, Bay, CP, Compliment, K, Herold, BC, Anastos, K, Minkoff, H, Kassaye, S, Seidman, DL, French, AL, Golub, E, Sheth, AN, Ochsenbauer, C, Swanstrom, R, Eron, JJ & Adimora, AA 2019, 'Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma', AIDS. https://doi.org/10.1097/QAD.0000000000002373
Nelson, Julie A.E. ; De Paris, Kristina ; Ramirez, Catalina ; Edmonds, Andrew ; Mollan, Katie R. ; Bay, Camden P. ; Compliment, Kara ; Herold, Betsy C. ; Anastos, Kathryn ; Minkoff, Howard ; Kassaye, Seble ; Seidman, Dominika L. ; French, Audrey L. ; Golub, Elizabeth ; Sheth, Anandi N. ; Ochsenbauer, Christina ; Swanstrom, Ronald ; Eron, Joseph J. ; Adimora, Adaora A. / Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma. In: AIDS. 2019.
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abstract = "Objective: Determine the frequency of genital HIV-1 shedding in a large cohort of women on longterm suppressive antiretroviral therapy (ART) and its association with mucosal inflammation. Design: We measured levels of HIV-1 RNA and inflammation biomarkers in cervicovaginal lavage (CVL) from HIV-seropositive women enrolled in the Women's Interagency HIV Study (WIHS). Methods: HIV-1 was quantified (Abbott RealTime HIV-1 assay) from CVL samples of 332 WIHS participants with and without clinical evidence of genital inflammation at the time of CVL collection; participants had suppressed plasma viral load (PVL) (limit of quantitation 20-4000 copies/ml depending on year of collection) for a median of 7.1 years (interquartile range=3.4-9.8, Group 1) or for a median of 1.0 years (IQR=0.5-1.0, Group 2). Twenty-two biomarkers of inflammation were measured in CVL to compare with clinical markers. Results: HIV-1 was detected in 47{\%} of 38 pre-ART CVL samples (median 668 copies/ml) and detection in CVL was associated with higher pre-ART PVL. HIV-1 was detected in only 1 of 38 CVL samples from these women on suppressive antiretroviral therapy for one year. No HIV-1 RNA was detected in 294 CVL samples from a cross-sectional set of women with suppressed PVL for a median of 7 years. Clinical inflammation markers were correlated with inflammatory biomarkers in CVL specimens, although genital inflammation was not associated with measurable genital HIV-1 shedding in these WIHS participants on ART. Conclusions: ART that suppresses HIV-1 in the plasma of women also prevents genital tract HIV-1 shedding, even in the presence of genital tract inflammation.",
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T1 - Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma

AU - Nelson, Julie A.E.

AU - De Paris, Kristina

AU - Ramirez, Catalina

AU - Edmonds, Andrew

AU - Mollan, Katie R.

AU - Bay, Camden P.

AU - Compliment, Kara

AU - Herold, Betsy C.

AU - Anastos, Kathryn

AU - Minkoff, Howard

AU - Kassaye, Seble

AU - Seidman, Dominika L.

AU - French, Audrey L.

AU - Golub, Elizabeth

AU - Sheth, Anandi N.

AU - Ochsenbauer, Christina

AU - Swanstrom, Ronald

AU - Eron, Joseph J.

AU - Adimora, Adaora A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: Determine the frequency of genital HIV-1 shedding in a large cohort of women on longterm suppressive antiretroviral therapy (ART) and its association with mucosal inflammation. Design: We measured levels of HIV-1 RNA and inflammation biomarkers in cervicovaginal lavage (CVL) from HIV-seropositive women enrolled in the Women's Interagency HIV Study (WIHS). Methods: HIV-1 was quantified (Abbott RealTime HIV-1 assay) from CVL samples of 332 WIHS participants with and without clinical evidence of genital inflammation at the time of CVL collection; participants had suppressed plasma viral load (PVL) (limit of quantitation 20-4000 copies/ml depending on year of collection) for a median of 7.1 years (interquartile range=3.4-9.8, Group 1) or for a median of 1.0 years (IQR=0.5-1.0, Group 2). Twenty-two biomarkers of inflammation were measured in CVL to compare with clinical markers. Results: HIV-1 was detected in 47% of 38 pre-ART CVL samples (median 668 copies/ml) and detection in CVL was associated with higher pre-ART PVL. HIV-1 was detected in only 1 of 38 CVL samples from these women on suppressive antiretroviral therapy for one year. No HIV-1 RNA was detected in 294 CVL samples from a cross-sectional set of women with suppressed PVL for a median of 7 years. Clinical inflammation markers were correlated with inflammatory biomarkers in CVL specimens, although genital inflammation was not associated with measurable genital HIV-1 shedding in these WIHS participants on ART. Conclusions: ART that suppresses HIV-1 in the plasma of women also prevents genital tract HIV-1 shedding, even in the presence of genital tract inflammation.

AB - Objective: Determine the frequency of genital HIV-1 shedding in a large cohort of women on longterm suppressive antiretroviral therapy (ART) and its association with mucosal inflammation. Design: We measured levels of HIV-1 RNA and inflammation biomarkers in cervicovaginal lavage (CVL) from HIV-seropositive women enrolled in the Women's Interagency HIV Study (WIHS). Methods: HIV-1 was quantified (Abbott RealTime HIV-1 assay) from CVL samples of 332 WIHS participants with and without clinical evidence of genital inflammation at the time of CVL collection; participants had suppressed plasma viral load (PVL) (limit of quantitation 20-4000 copies/ml depending on year of collection) for a median of 7.1 years (interquartile range=3.4-9.8, Group 1) or for a median of 1.0 years (IQR=0.5-1.0, Group 2). Twenty-two biomarkers of inflammation were measured in CVL to compare with clinical markers. Results: HIV-1 was detected in 47% of 38 pre-ART CVL samples (median 668 copies/ml) and detection in CVL was associated with higher pre-ART PVL. HIV-1 was detected in only 1 of 38 CVL samples from these women on suppressive antiretroviral therapy for one year. No HIV-1 RNA was detected in 294 CVL samples from a cross-sectional set of women with suppressed PVL for a median of 7 years. Clinical inflammation markers were correlated with inflammatory biomarkers in CVL specimens, although genital inflammation was not associated with measurable genital HIV-1 shedding in these WIHS participants on ART. Conclusions: ART that suppresses HIV-1 in the plasma of women also prevents genital tract HIV-1 shedding, even in the presence of genital tract inflammation.

KW - cervicovaginal lavage

KW - genital HIV-1 shedding

KW - genital inflammation

KW - inflammation biomarkers

KW - suppressed

KW - WIHS

KW - women

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