Cervicovaginal HIV-1 shedding in women taking antiretroviral therapy in Burkina Faso: a longitudinal study

Andrea J Low, Issouf Konate, Nicolas Nagot, Helen A Weiss, Dramane Kania, Peter Vickerman, Michel Segondy, David Mabey, Deenan Pillay, Nicolas Meda, Philippe van de Perre, Philippe Mayaud, Yerelon Study Group

Research output: Contribution to journalArticle (Academic Journal)

19 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)237-45
Number of pages9
JournalJournal of Acquired Immune Deficiency Syndromes
Volume65
Issue number2
DOIs
Publication statusPublished - 1 Feb 2014

Keywords

  • Adolescent
  • Adult
  • Antiretroviral Therapy, Highly Active
  • Burkina Faso
  • Cohort Studies
  • Female
  • Genitalia, Female
  • HIV Infections
  • HIV-1
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Plasma
  • RNA, Viral
  • Risk Factors
  • Viral Load
  • Virus Shedding
  • Young Adult

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