GENITAL SHEDDING OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 DNA DURING PREGNANCY - ASSOCIATION WITH IMMUNOSUPPRESSION, ABNORMAL CERVICAL OR VAGINAL DISCHARGE, AND SEVERE VITAMIN-A DEFICIENCY

The presence of human immunodeficiency virus type 1 (HIV-1) in genital secretions may be a determinant of vertical HIV-1 transmission. Cervi cal and vaginal secretions from HIV-1-seropositive pregnant women were evaluated to determine prevalence and correlates of HIV-1-infected ce lls in the genital tract. HIV-1 DNA was detected by polymerase chain r eaction in 32% of 212 cervical and 10% of 215 vaginal specimens. Prese nce of HIV-1 DNA in the cervix was associated with cervical mucopus an d a significantly lower absolute CD4 cell count (354 vs. 469, P < .001 ). An absolute CD4 cell count <200 was associated with a 9.6-fold incr eased odds of cervical HIV-1 DNA detection compared with a count great er than or equal to 500 (95% confidence interval, 2.8-34.2). Detection of vaginal HIV-1 DNA was associated with abnormal vaginal discharge, lower absolute CD4 cell count, and severe vitamin A deficiency. Presen ce of HIV-1-infected cells in genital secretions was associated with i mmunosuppression and abnormal cervical or vaginal discharge.