HORMONAL CONTRACEPTION, VITAMIN-A-DEFICIENCY, AND OTHER RISK-FACTORS FOR SHEDDING OF HIV-1-INFECTED CELLS FROM THE CERVIX AND VAGINA

Background Factors that influence shedding of HIV-1 infected cells in cervical and vaginal secretions may be important determinants of sexua l and vertical transmission of the virus. We investigated whether horm onal contraceptive use, vitamin A deficiency, and other variables were risk factors for cervical and vaginal shedding of HIV-infected cells. Methods Between December, 1994, and April, 1996, women who attended a municipal sexually transmitted diseases (STDs) clinic in Mombasa, Ken ya, and had previously tested positive for HIV-1, were invited to take part in our cross-sectional study. Cervical and vaginal secretions fr om 318 women were evaluated for the presence of HIV-1 infected cells b y PCR amplification of gag DNA sequences.Findings HIV-1 infected cells were detected in 51% of endocervical and 14% of vaginal-swab specimen s. Both cervical and vaginal shedding of HIV-1 infected cells were hig hly associated with CD4 lymphocyte depletion (p=0.0000) and p=0.003, r espectively). After adjustment for CD4 count, cervical proviral sheddi ng was significantly associated with use of depot medroxyprogesterone acetate (odds ratio 2.9, 95% CI 1.5-5.7), and with use of low-dose and high-dose oral contraceptive pills (3.8, 1.4-9.9 and 12.3, 1.5-101, r espectively), Vitamin A deficiency was highly predictive of vaginal HI V-1 DNA shedding. After adjustment for CD4 count, severe vitamin A def iciency, moderate deficiency, and low normal vitamin A status were ass ociated with 12.9, 8.0, and 4.9-fold increased odds of vaginal sheddin g, respectively. Gonococcal cervicitis (3.1, 1.1-9.8) and vaginal cand idiasis (2.6, 1.2-5.4) were also correlated with significant increases in HIV-1 DNA detection, but Chlamydia trachomatis and Trichomonas vag inalis were not. Interpretation Our study documents several novel corr elates of HIV-1 shedding in cervical and vaginal secretions, most nota bly hormonal contraceptive use and vitamin A deficiency. These factors may be important determinants of sexual or vertical transmission of H IV-1 and are of public health importance because they are easily modif ied by simple interventions.