Genital tract human immunodeficiency virus type 1 (HIV-1) shedding and inflammation and HIV-1 env diversity in perinatal HIV-1 transmission

This study sought to identify genital tract characteristics associated with vertical transmission of human immunodeficiency virus type 1 (HIV-1). HIV- 1 DNA and RNA, HIV-1 env diversity, and inflammatory cells were quantified in cervicovaginal lavages (CVLs) of 24 women enrolled in the Women and Infa nts Transmission Study; 7 women transmitted HIV-1 perinatally, Vaginal cand idiasis, HIV-1 culture positivity levels of HIV-1 DNA and cell-free RNA, an d HIV-1 env diversity were significantly higher in the CVLs of transmitters . CVL HIV-1 DNA levels correlated with higher levels of inflammatory cells and cell-free HIV-1 RNA, Of subjects with paired blood and CVL specimens, t here was more HIV-1 env heterogeneity between blood and CVLs in transmitter s than in nontransmitters. In summary, increased HIV-1, shedding is correla ted with a more complex population of HIV-1 quasispecies in the genital tra cts of parturient women, which may increase the probability that a fetotrop ic strain is transmitted.