CERVICAL AND VAGINAL SHEDDING OF HUMAN-IMMUNODEFICIENCY-VIRUS TYPE 1-INFECTED CELLS THROUGHOUT THE MENSTRUAL-CYCLE

Cervical and vaginal secretions from 17 women infected with human immu nodeficiency virus type 1 (HIV-1) were evaluated daily through the cou rse of one menstrual cycle for HIV-1 DNA (21-31 visits per woman). HIV -1-infected cells were detected in 207 (46%) of 450 endocervical swabs and 74 (16%) of 449 vaginal swabs. There was considerable variability in the percentage of positive swabs from each woman, ranging from 4% to 100% of endocervical swabs and from 0 to 71% of vaginal swabs. In m ultivariate analyses, plasma HIV-1 RNA was significantly associated wi th shedding of HIV-1-infected cells; each 1-unit increase in the log o f plasma virus load was associated with a 5.6-fold increase in the odd s of cervical shedding (95% confidence interval [CI], 2.1-14.8) and a 3.9-fold increase in the odds of vaginal shedding (95% CI, 2.1-7.2). T here was no discernible pattern of genital tract shedding with phase o f the menstrual cycle and no significant association with serum estrad iol or progesterone levels.