Viral excretion in cervicovaginal secretions of HIV-1-infected women receiving antiretroviral therapy

A longitudinal study was conducted to evaluate the viral shedding present i n cervicovaginal secretions of HIV-l-seropositive women receiving antiretro viral therapy. A total of 128 paired cervicovaginal and blood samples was o btained from 37 women during a median follow-up period of 21 months. A sens itive, competitive, polymerase chain reaction and a reverse transcription p olymerase chain reaction were used for the simultaneous quantitation of HIV -1 proviral DNA and RNA in cervicovaginal cells and cell-free RNA in cervic ovaginal secretions, as well as HIV-1 RNA in peripheral blood. The cumulati ve probability of detecting proviral DNA in genital secretions was signific antly higher over time in women with detectable ge viremia than in women in whom HIV-1 RNA was persistently undetectable in plasma (<50 copies/ml) (P= 0,028 by log-rank test). The presence and amount of proviral DNA, cell-asso ciated RNA and cell-free RNA in the cervicovaginal secretions were positive ly correlated with the presence of detectable viremia or the number of HIV- 1 RNA copies in plasma (Spearman rank correlation, 0.290, 0.279, and 0.305, respectively; all P < 0.01), but no correlation was found with the CD4+ ce ll count. In addition, vaginal infections were positively correlated with t he detection of proviral DNA in cervicovaginal secretions (odds ratio, 2.60 ; 95% confidence interval, 1.07-5.70). However, the positive correlation be tween the presence and amount of HIV in cervicovaginal secretions and the v iral load in plasma provides no assurance that HIV shedding does not occur in the genital tract of women with undetectable HIV-RNA in plasma.