Effect of highly active antiretroviral therapy on cervicovaginal HIV-1 RNA

Objectives: To determine the frequency of cervicovaginal lavage and plasma HIV-1 RNA levels that are below detectable levels (< 400 copies/ml) among w omen on highly active antiretroviral therapy (HAART), non-HAART and on no t herapy. To compare the effect of initiating HAART on the timing of HIV-1 RN A suppression in the blood plasma and genital tract among antiretroviral-na ive women. Methods: Data were obtained from 205 HIV-infected women with paired plasma and cervicovaginal lavage viral load measurements. Seven antiretroviral-nai ve women starling HAART had viral load measurements performed daily for one week, at 2 weeks and at 1 month after initiating therapy. Viral load quant ification was carried out by nucleic acid sequence-based amplification assa y. The lower limit of detection was 400 copies/ml. Results: Plasma and cervicovaginal HIV-1 RNA was delectable in 71 and 26% o f the women, respectively. Among women with plasma viral loads less than 40 0, 400-9999, and 10 000 copies/ml or over, genital tract HIV-1 RNA was dete cted in 3, 17 and 48%, respectively (P<0.001). Fifty-one per cent of the wo men with CD4 cell counts of less than 200/mm(3) had detectable cervicovagin al viral loads compared with 18% among women with CD4 cell counts of 200/mm 3 or over (P<0.001). Cervicovaginal HIV-1 RNA was less than 400 copies/ml i n 85% of those on HAART, 69% of those on non-HAART and 69% of those on no t herapy (P<0.045). In seven antiretroviral-nai:ve women initiating HAART, ce rvicovaginal HIV-1 RNA decreased by 0.7-2.1 log(10) within 1 -14 days of st arting therapy. Conclusion: The cervicovaginal HIV-1 RNA level was positively correlated wi th plasma HIV-1 RNA and negatively with the CD4 cell count. The use of HAAR T was significantly associated with below-detectable levels of HIV-1 RNA in both plasma and the genital tract. HIV-1 RNA suppression in the genital tr act may occur rapidly after initiating therapy. (C) 2000 Lippincott William s & Wilkins.