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Female genital tract shedding of HIV-1 is rare in women with suppressed HIV-1 in plasma.

  • Nelson, Julie A E1, 2
  • de Paris, Kristina1, 2
  • Ramirez, Catalina3
  • Edmonds, Andrew4
  • Mollan, Katie R1, 4
  • Bay, Camden P1
  • Compliment, Kara1
  • Herold, Betsy C5
  • Anastos, Kathryn6
  • Minkoff, Howard7
  • Kassaye, Seble8
  • Seidman, Dominika L9
  • French, Audrey L10
  • Golub, Elizabeth T11
  • Sheth, Anandi N12
  • Ochsenbauer, Christina13
  • Swanstrom, Ronald1, 14
  • Eron, Joseph J1, 3
  • Adimora, Adaora A1, 3, 4
  • 1 UNC Center for AIDS Research.
  • 2 Department of Microbiology and Immunology.
  • 3 Department of Medicine.
  • 4 Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
  • 5 Department of Pediatrics and Microbiology-Immunology, Albert Einstein College of Medicine, Bronx, NY.
  • 6 Department of Medicine, Albert Einstein College of Medicine, Bronx, NY.
  • 7 Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY.
  • 8 Division of Infectious Diseases and Travel Medicine, Georgetown University, Washington, DC.
  • 9 Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA.
  • 10 The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, IL.
  • 11 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
  • 12 Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA.
  • 13 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
  • 14 Department of Biochemistry and Biophysics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Published Article
AIDS (London, England)
Publication Date
Sep 02, 2019
DOI: 10.1097/QAD.0000000000002373
PMID: 31483374


Determine the frequency of genital HIV-1 shedding in a large cohort of women on long-term suppressive antiretroviral therapy (ART) and its association with mucosal inflammation. We measured levels of HIV-1 RNA and inflammation biomarkers in cervicovaginal lavage (CVL) from HIV-seropositive women enrolled in the Women's Interagency HIV Study (WIHS). HIV-1 was quantified (Abbott RealTime HIV-1 assay) from CVL samples of 332 WIHS participants with and without clinical evidence of genital inflammation at the time of CVL collection; participants had suppressed plasma viral load (PVL) (limit of quantitation <20-4000 copies/ml depending on year of collection) for a median of 7.1 years (interquartile range=3.4-9.8, Group 1) or for a median of 1.0 years (IQR = 0.5-1.0, Group 2). Twenty-two biomarkers of inflammation were measured in CVL to compare with clinical markers. HIV-1 was detected in 47% of 38 pre-ART CVL samples (median 668 copies/ml) and detection in CVL was associated with higher pre-ART PVL. HIV-1 was detected in only 1 of 38 CVL samples from these women on suppressive antiretroviral therapy for one year. No HIV-1 RNA was detected in 294 CVL samples from a cross-sectional set of women with suppressed PVL for a median of 7 years. Clinical inflammation markers were correlated with inflammatory biomarkers in CVL specimens, although genital inflammation was not associated with measurable genital HIV-1 shedding in these WIHS participants on ART. ART that suppresses HIV-1 in the plasma of women also prevents genital tract HIV-1 shedding, even in the presence of genital tract inflammation.

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