Effect of menstrual cycle on HIV-1 levels in the peripheral blood and genital tract

Objective: To assess the variation in HIV-1 over the menstrual cycle, inclu ding RNA levels in the female genital tract, plasma HIV-1-RNA levels, CD4 c ell counts, and culturable virus. Design: A prospective analysis of 55 HIV-1-infected women. Methods: Blood and genital tract specimens were collected weekly over 8 wee ks, spanning two complete menstrual cycles. Applying repeated-measures mode ls that used menses as the reference level, the variation in viral RNA leve ls was compared in endocervical canal fluid and cells (collected by Sno-str ips and cytobrush, respectively) and ectocervicovaginal lavage (CVL) fluid. Repeated-measures models were also used to assess the variation in plasma CD4 cell counts and viral load. Results: Shedding patterns differed among the three sampling methods, indep endent of genital tract co-infections. Genital tract HIV-1-RNA levels from CVL fluid and endocervical canal cytobrush specimens were highest during me nses and lowest immediately thereafter (P = 0.001 and P = 0.04). The HIV-I- RNA level in endocervical canal fluid was highest in the week preceding men ses(P = 0.003). The menstrual cycle had no effect on blood levels of RNA (P = 0.62), culturable virus (P = 0.34), or CD4 cell counts (P = 0.55). HIV-I -RNA levels were higher in endocervical canal fluid than in peripheral bloo d plasma during the late luteal phase (P = 0.03). Conclusion: HIV-1-RNA levels vary with the menstrual cycle in the female ge nital tract but not the blood compartment. HIV-I-RNA levels are higher in e ndocervical canal fluid than in blood plasma. These findings may have impor tant implications for sex-specific pathogenesis, heterosexual transmission, and contraceptive hormone interventions in HIV-l-infected women. (C) 2000 Lippincott Williams & Wilkins.