Initiation of antiretroviral therapy leads to a rapid decline in cervical and vaginal HIV-1 shedding

被引:113
作者
Graham, Susan M.
Holte, Sarah E.
Peshu, Norbert M.
Richardson, Barbra A.
Panteleeff, Dana D.
Jaoko, Walter G.
Ndinya-Achola, Jeckoniah O.
Mandaliya, Kishorchandra N.
Overbaugh, Julie M.
McClelland, R. Scott
机构
[1] Univ Washington, Dept Med, Int AIDS Res & Training Program, Seattle, WA 98104 USA
[2] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[3] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
[4] Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, Seattle, WA 98104 USA
[5] Fred Hutchinson Canc Res Ctr, Div Human Biol, Seattle, WA 98104 USA
[6] Kenya Govt Med Res Ctr, Kilifi, Kenya
[7] Univ Nairobi, Dept Med Microbiol, Nairobi, Kenya
[8] Coast Provincial Gen Hosp, Mombasa, Kenya
关键词
AIDS; antiretroviral therapy; cervix; female; HIV-1; vagina; virus shedding;
D O I
10.1097/QAD.0b013e32801424bd
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Antiretroviral therapy (ART) may decrease HIV-1 infectivity in women by reducing genital HIV-1 shedding. Objectives: To evaluate the time course and magnitude of decay in cervical and vaginal HIV-1 shedding as women initiate ART. Methods: This prospective, observational study of 20 antiretroviral-naive women initiating ART with stavudine, lamivudine, and nevirapine measured HIV-1 RNA in plasma, cervical secretions, and vaginal secretions. Qualitative polymerase chain reaction estimated HIV-1 DNA in cervical and vaginal samples. Perelson's two-phase viral decay model and non-linear random effects were used to compare RNA decay rates. Decreases in proviral DNA were evaluated using logistic regression and generalized estimating equations. Results: Significant decreases in the quantity of HIV-1 RNA were observed by day 2 in plasma (P < 0.001), day 2 in cervical secretions (P=0.001), and day 4 in vaginal secretions (P < 0.001). Modeled initial and subsequent RNA decay rates in plasma, cervical secretions, and vaginal secretions were 0.6, 0.8, and 1.2 log(10) virions/day, and 0.04, 0.05, and 0.06 log(10) virions/day, respectively. The initial decay rate for vaginal HIV-1 RNA was more rapid than for plasma RNA (P=0.02). Detection of HIV-1 DNA decreased significantly in vaginal secretions during the first week (P < 0.001). At day 28, 10 women had detectable HIV-1 RNA or proviral DNA in genital secretions. Conclusions: Genital HIV-1 shedding decreased rapidly after ART initiation, consistent with a rapid decrease in infectivity. However, incomplete viral suppression in half of these women may indicate an ongoing risk of transmission. (c) 2007 Lippincott Williams & Wilkins.
引用
收藏
页码:501 / 507
页数:7
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