dc.description.abstract | Background
Cervicitis increases the quantity of HIV-1 RNA in cervical secretions when women are not taking antiretroviral therapy (ART), and successful treatment of cervicitis reduces HIV-1 shedding in this setting.
Objective
To determine the effect of acquisition and treatment of cervical infections on genital HIV-1 shedding in women receiving ART.
Design
Prospective cohort study.
Methods
We followed 147 women on ART monthly for incident non-specific cervicitis, gonorrhea, and chlamydia. Cervical swabs for HIV-1 RNA quantitation were collected at every visit. The lower limit for linear quantitation was 100 copies/swab. We compared the prevalence of HIV-1 RNA detection before (baseline) versus during and after treatment of cervical infections.
Results
Thirty women contributed a total of 31 successfully treated episodes of non-specific cervicitis (N=13), gonorrhea (N=17), and chlamydia (N=1). HIV-1 RNA was detected in cervical secretions before, during, and after cervicitis at 1 (3.2%), 5 (16.1%), and 3 (9.7%) visits respectively. Compared to baseline, detection of HIV-1 RNA was increased when cervical infections were present (adjusted odds ratio 5.7, 95% confidence interval 1.0–30.3, P=0.04). However, even in the subset of women with cervical HIV-1 RNA levels above the threshold for quantitation, most had low concentrations during cervical infections (median 115, range 100–820 copies/swab).
Conclusions
While these data show a statistically significant increase in cervical HIV-1 RNA detection when cervical infections are present, most cervical HIV-1 RNA concentrations were near the threshold for detection, suggesting that infectivity remains low. Antiretroviral therapy appears to limit increases in genital HIV-1 shedding caused by cervical infections. | en_US |