Abstract
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 language | English (US) |
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Pages (from-to) | 755-759 |
Number of pages | 5 |
Journal | AIDS |
Volume | 21 |
Issue number | 6 |
DOIs | |
State | Published - Mar 2007 |
Externally published | Yes |
Keywords
- Bacterial vaginosis
- Cervicitis
- Endometritis
- HIV-1
- Infectivity
- Kenya
- Pelvic inflammatory disease
- Shedding
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
- Infectious Diseases