The effect of treatment of vaginal infections on shedding of human immunodeficiency virus type 1

To assess the effect of treatment of vaginal infections on vaginal shedding of cell-free human immunodeficiency virus type 1 (HIV-1) and HIV-1-infecte d cells, HIV-1-seropositive women were examined before and after treatment of Candida vulvovaginitis, Trichomonas vaginitis, and bacterial vaginosis. For Candida (n = 98), vaginal HIV-1 RNA decreased from 3.36 to 2.86 log(10) copies/swab (P <.001), as did the prevalence of HIV-1 DNA (36% to 17%; odd s ratio [OR], 2.8; 95% confidence interval [CI], 1.3-6.5). For Trichomonas vaginitis (n = 55), HIV-1 RNA decreased from 3.67 to 3.05 log(10) copies/sw ab (P <.001), but the prevalence of HIV-1 DNA remained unchanged (22%-25%; OR, 0.8; 95% CI, 0.3-2.2). For bacterial vaginosis (n = 73), neither the sh edding of HIV-1 RNA (from 3.11 to 2.90 log(10) copies/swab; P = .14) nor th e prevalence of DNA (from 21% to 23%; OR, 0.8; 95% CI, 0.3-2.0) changed. Va ginal HIV-1 decreased 3.2- and 4.2-fold after treating Candida and Trichomo nas, respectively. These data suggest that HIV-1 transmission intervention strategies that incorporate diagnosis and treatment of these prevalent infe ctions warrant evaluation.