Cervico-vaginal HIV-1 shedding in women taking antiretroviral therapy in Burkina Faso: A longitudinal study.

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Low, AJ ; Konate, I ; Nagot, N ; Weiss, HA ; Kania, D ; Vickerman, P ; Segondy, M ; Mabey, D ; Pillay, D ; Meda, N ; van de Perre, P ; Mayaud, P (2013)
  • Publisher: Lippincott, Williams & Wilkins
  • Journal: Journal of Acquired Immune Deficiency Syndromes (1999), volume 65, issue 2, pages 237-245 (issn: 1525-4135, eissn: 1944-7884)
  • Related identifiers: doi: 10.1097/QAI.0000000000000049, pmc: PMC3979829
  • Subject: nevirapine | antiretrovirals | bacterial vaginosis | cervicovaginal lavage | HIV-1 RNA | herpes simplex virus type-2 | Epidemiology and Prevention
    mesheuropmc: virus diseases

Background: Antiretroviral therapy (ART) reduces transmission of HIV-1. However, genital HIV-1 can be detected in patients on ART. We analyzed factors associated with genital HIV-1 shedding among high-risk women on ART in Burkina Faso. Methods: Plasma viral load (PVL) and enriched cervicovaginal lavage HIV-1 RNA were measured every 3–6 months for up to 8 years. Random-effects logistic and linear regression models were used to analyze associations of frequency and quantity of genital HIV-1 RNA with behavioral and biological factors, adjusting for within-woman correlation. The lower limit of detection of HIV-1 RNA in plasma and eCVL samples was 300 copies per milliliter. Results: One hundred and eighty-eight participants initiated ART from 2004 to 2011. PVL was detectable in 16% (171/1050) of visits, in 52% (90/174) of women. Cervicovaginal HIV-1 RNA was detectable in 16% (128/798) of visits with undetectable plasma HIV-1 RNA in 45% (77/170) of women. After adjusting for PVL, detectable cervicovaginal HIV-1 RNA was independently associated with abnormal vaginal discharge and use of nevirapine or zidovudine vs. efavirenz and stavudine, respectively; longer time on ART and hormonal contraception were not associated with increased shedding. The presence of bacterial vaginosis, herpes simplex virus-2 DNA, and the use of nevirapine vs efavirenz were independently associated with an increased quantity of cervicovaginal HIV-1 RNA. Conclusions: Certain ART regimens, abnormal vaginal discharge, bacterial vaginosis, and genital herpes simplex virus-2 are associated with HIV-1 cervicovaginal shedding or quantity in women on ART after adjusting for PVL. This may reduce the effectiveness of ART as prevention in high-risk populations.
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