A comparison of genital HIV-1 shedding and sexual risk behavior among Kenyan women based on eligibility for initiation of HAART according to WHO guidelines
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Date
2006Author
McClelland, RS
Baeten, JM
Richardson, BA
Lavreys, L
Emery, S
Mandaliya, K
Ndinya-Achola Jeckoniah O.
Overbaugh, J
Type
ArticleLanguage
enMetadata
Show full item recordAbstract
BACKGROUND:
Guidelines for initiating antiretrovirals are based on markers of advanced disease and are not directly linked to markers of HIV-1 transmission such as viral shedding.
METHODS:
We evaluated genital HIV-1 shedding and risk behavior among 650 antiretroviral-naïve women stratified by WHO criteria for initiating antiretrovirals based on CD4 count and symptoms.
RESULTS:
Genital HIV-1 concentrations increased in stepwise fashion with declining CD4 counts and the presence of symptoms. Compared with the reference group (asymptomatic with CD4 >350 cells/microL), those with advanced immunosuppression (CD4 <200 cells/microL) had significantly higher cervical HIV-1 RNA concentrations (2.4 log10 copies/swab vs. 3.8 log10 copies/swab, P < 0.001). However, women with CD4 counts <200 cells/microL were also less likely than the reference group to report intercourse during the past week (58% vs. 26%, P < 0.001).
CONCLUSIONS:
Antiretroviral guidelines focusing on individuals with the most advanced immunosuppression will target those with the highest genital HIV-1 concentrations. However, individuals with less advanced immunosuppression also have high levels of genital HIV-1 and may be more sexually active. The effect of increased antiretroviral availability on the spread of HIV-1 might be enhanced by extending treatment, in addition to other risk reduction services, to those with less advanced disease
URI
http://www.ncbi.nlm.nih.gov/pubmed/16652035http://erepository.uonbi.ac.ke:8080/xmlui/handle/123456789/16638
Citation
J Acquir Immune Defic Syndr. 2006 Apr 15;41(5):611-5Publisher
Department of Medical Microbiology, University of Nairobi Departments of Medicine, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104, USA
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- Faculty of Health Sciences (FHS) [10377]