Factors associated with nucleic acids related to human immunodeficiency virus type 1 in cervico-vaginal secretions

Objective To assess HIV-related nucleic acids in cervico-vaginal secretions and the factors associated with them. Design Observational study. Setting Department of Obstetrics and Gynaecology, University of Pavia, Ital y. Population HIV-positive patients attending a cytology service. Methods Paired blood and cervico-vaginal lavage samples were obtained from 122 known HIV-seropositive patients during periodic visits for cytologic sc reening for lower genital tract neoplasia. Vaginal specimens for the diagno sis of bacterial vaginosis, trichomonas vaginalis and candida infection wer e also obtained. HIV-1-RNA in plasma, proviral HIV-1-DNA, cell associated a nd cell-free HIV-1-RNA in cervico-vaginal secretions were quantitatively ev aluated by competitive polymerase chain reaction (c-PCR) and reverse transc riptase PCR (cRT-PCR). Main outcome measure Prevalences of HIV related nucleic acids in cervico-va ginal secretions and their univariate and multivariate associations with cl inical variables. Results Proviral HIV-1 DNA, cell-associated and cell-free HIV-1 RNA were de tected in 50% (61/122), 37.7% (46/122) and 32.8% (40/122) of the patients, respectively. In logistic regression analysis, the presence of HIV-1 RNA in blood was the factor which correlated best with the detection of HIV-1 DNA (OR = 5.48, 95% CI = 2.28-13.20), cell-associated (OR = 4.85; 95% CI = 1.8 9-12.45) and cell-free HIV-1 RNA (OR = 4.63, 95% CI = 1.74-12.33) in cervic o-vaginal samples. However, between 20% and to 35% of patients who tested n egative for blood HIV-1 RNA were positive for either HIV-1 DNA or HIV-1 RNA detection in cervico-vaginal lavages. Bacterial vaginosis was associated w ith an increased prevalence of cell-associated (OR = 3.58, 95% CI = 1.22-10 .54) and cell-free HIV-1 RNA(OR = 2.94, 95% CI = 1.0-8.7) detection in cerv ico-vaginal secretions. Additional factors associated with increased preval ence of HIV-1 RNA detection were advanced stage of HIV disease and vulvovag inal candidiasis. Conclusions Although the presence of HIV-1 RNA in blood is the factor which correlates best with the detection of HIV-related nucleic acids in cervico -vaginal secretions, the shedding of HIV in the genital tract can occur in 20-30% of non-viremic subjects. Bacterial vaginosis and candida infection c ould have a facilitating role in local HIV viral replication and shedding.