Determinants of HIV-1 shedding in the genital tract of women

Andrea Kovacs, Steven S. Wasserman, David Burns, David J. Wright, Jonathan Cohn, Alan Landay, Kathleen Weber, Mardge Cohen, Alexandra Levine, Howard Minkoff, Paolo Miotti, Joel Palefsky, Mary Young, Patricia Reichelderfer

Research output: Contribution to journalArticlepeer-review

202 Scopus citations

Abstract

Background: Plasma HIV-1 RNA concentration has been the best predictor for risk of heterosexual and perinatal transmission. However, direct contact with HIV-1 present locally in the genital tract might be necessary for transmission. We aimed to assess the relation between HIV-1 shedding (RNA or culturable virus) in female genital secretions and other factors that might affect HIV-1 shedding. Methods: This was a cross-sectional study within the Women's Interagency HIV Study (WIHS), a prospective longitudinal cohort study of HIV-infected women. We enrolled 311 HIV positive women from Jan 30, 1997 to July 1, 1998. We did clinical assesments, cultured HIV-1, and measured RNA in peripheral blood mononuclear cells (PBMC) and genital secretions. We compared the results with univariate and multivariate analyses. Presence of HIV-1 RNA or culturable virus in genital secretions was defined as HIV-1 shedding. Findings: HIV-1 RNA was present in genital secretions of 57% (152/268) of women whereas infectious virus was detected only in 6% (17/271). Genital tract HIV-1 shedding was found in 80% (130/163) of women with detectable plasma RNA and 78% (116/148) of women with positive PBMC cultures. 33% (27/83) of women with less than 500 copies/mL plasma RNA and 39% (35/90) of those with negative PBMC cultures also had genital tract shedding. Interpretation: Plasma RNA concentration, both qualitatively and quantitatively, was the most important factor in predicting genital HIV-1 shedding, even among women receiving potent antiretroviral therapy. However, HIV-1 shedding did occur in women with less than 500 copies/mL plasma HIV-1 RNA. This finding suggests that a separate reservoir of HIV-1 replication may exist in some women.

Original languageEnglish (US)
Pages (from-to)1593-1601
Number of pages9
JournalLancet
Volume358
Issue number9293
DOIs
StatePublished - Nov 10 2001
Externally publishedYes

ASJC Scopus subject areas

  • General Medicine

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