Infectious correlates of HIV-1 shedding in the female upper and lower genital tracts

Jenell S. Coleman, Jane Hitti, Elizabeth A. Bukusi, Christina Mwachari, Angela Muliro, Rosemary Nguti, Reggie Gausman, Sarah Jensen, Dorothy Patton, David Lockhart, Robert Coombs, Craig R. Cohen

Research output: Contribution to journalArticlepeer-review

79 Scopus citations


OBJECTIVES: To determine the effects of vaginal, cervical, and endometrial infections on shedding of HIV-1 RNA in the female genital tract. DESIGN: Cross-sectional. METHODS: Antiretroviral-naive women from Nairobi, Kenya with CD4 cell counts ≥ 350 cells/μl had plasma and endocervical wick samples collected for HIV quantification by real-time RNA reverse transcriptase- polymerase chain reaction. Vaginal and cervical Gram stains and endometrial biopsies were obtained. Vaginal Gram stain was used to diagnose bacterial vaginosis and to quantify Lactobacillus levels. RESULTS: Twenty-six of 50 (52%) women had detectable endocervical HIV-1 RNA with a median endocervical viral load of 1760 copies/ml (range: undetectable to 1 030 000 copies/ml). Women with decreased Lactobacillus had 15.8-fold [95% confidenceinterval (CI), 2.0-123] greater endocervical HIV-1 RNA than women with normal Lactobacillus levels. Women with plasma cell (PC) endometritis [≥ 1 PC/high-power field (hpf)] had a 15.8-fold (95% CI, 2.0-120) higher endocervical HIV RNA level than women without PC endometritis. Both these associations remained after controlling for plasma viral load. Cervicitis (≥ 30 polymorphonuclear leukocytes/hpf), however, was not associated with endocervical HIV-1 RNA shedding (P = 0.81). CONCLUSIONS: In HIV-1-infected, antiretroviral-naive women without symptoms of pelvic inflammatory disease infection, abnormal vaginal flora and inflammatory cells in the endometrium affected HIV-1 shedding from the lower genital tract. These data suggest that both the upper and lower genital tracts contribute to female HIV-1 genital shedding.

Original languageEnglish (US)
Pages (from-to)755-759
Number of pages5
Issue number6
StatePublished - Mar 2007
Externally publishedYes


  • Bacterial vaginosis
  • Cervicitis
  • Endometritis
  • HIV-1
  • Infectivity
  • Kenya
  • Pelvic inflammatory disease
  • Shedding

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases


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