Human immunodeficiency virus 1 expression in the female genital tract in association with cervical inflammation and ulceration

OBJECTIVES: Determining the source of human immunodeficiency virus 1 in the female genital tract and identifying factors that influence the amount of virus shed are important in the understanding of heterosexual human immunod eficiency virus 1 transmission. STUDY DESIGN: Cervicovaginal human immunodeficiency virus 1 ribonucleic aci d shedding was quantified before and after treatment of cervical squamous i ntraepithelial lesions in 14 women. Genotypic analysis was performed on pep tide HIV-1 env gp120 of the major human immunodeficiency virus 1 species in plasma and cervicovaginal lavage of selected samples. RESULTS: At 2 to 4 weeks after treatment, when cervices were inflamed and u lcerated, human immunodeficiency virus 1 ribonucleic acid in ravage samples increased 1.0 to 4.4 log 10. Genotypic analysis showed significant differe nces between the predominant human immunodeficiency virus 1 species in pair ed plasma and lavage samples from 2 of 4 women, suggesting that the increas e in human immunodeficiency virus 1 was the result of local viral replicati on. CONCLUSIONS: Cervical inflammation and ulceration are associated with local human immunodeficiency virus 1 expression, which increases as much as 10,0 00-fold the amount of human immunodeficiency virus 1 shed into genital secr etions. This may explain why sexually transmitted diseases are important ri sk factors for human immunodeficiency virus transmission.