Cervical Shedding of HIV-1 RNA Among Women With Low Levels of Viremia While Receiving Highly Active Antiretroviral Therapy

Authors:
  • LBLorie Benning
    Lorie Benning
  • JXJiaao Xu
    Jiaao Xu
  • HSHoward D Strickler
    Howard D Strickler
  • RGRuth M Greenblatt
    Ruth M Greenblatt
  • HMHoward Minkoff
    Howard Minkoff
  • MYMary Young
    Mary Young
  • JBJames Bremer
    James Bremer
  • ALAlexandra M Levine
    Alexandra M Levine
  • AKAndrea Kovacs
    Andrea Kovacs
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Abstract
Background: Among women with low or undetectable quantities of HIV-1 RNA in plasma, factors associated with genital HIV-1 RNA shedding, including choice of treatment regimen, are poorly characterized. Methods: We measured HIV-1 RNA in cervical swab specimens obtained from participants in the Women's Interagency HIV Study who had concurrent plasma viral RNA levels <500 copies/mL, and we assessed factors associated with genital HIV shedding. The study was powered to determine the relative effects of antiretroviral protease inhibitors (PIs) versus nonnucleoside reverse transcriptase inhibitors (NNRTIs) on viral RNA shedding. Results: Overall, 44 (15%) of 290 women had detectable HIV-1 RNA in cervical specimens. In the final multivariate model, shedding was independently associated with NNRTI (vs. PI) use (odds ratio [OR], 95% confidence interval [CI]: 2.24, 1.13 to 4.45) and illicit drug use (OR, 95% CI: 2.41, 0.96 to 5.69). Conclusions: This is the largest study to define risks for genital HIV-1 RNA shedding in women with low/undetectable plasma virus. Shedding in this population was common, and NNRTI-based highly active antiretroviral therapy (HAART) (vs. PI-based HAART) was associated with genital HIV shedding. Further study is required to determine the impact of these findings on transmission of HIV from mother to child or to sexual partners.

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