Female genital shedding of HIV-1 poses infection risk

November 08, 2001

N.B. Please note that if you are outside North America the embargo for Lancet press material is 0001 hours UK time Friday 9 November 2001.

A study in this week's issue of THE LANCET suggests that heterosexual women with HIV-1-including those who have had successful antiretroviral therapy-are at risk of transmitting HIV to their sexual partners and newborn infants as a result of viral shedding in the genital tract.

Plasma HIV-1 RNA concentration has been the best predictor for risk of heterosexual and perinatal transmission. However, direct contact with HIV-1 present locally in the genital tract might be necessary for transmission. Andrea Kovacs, from the Keck School of Medicine of the University of Southern California, Los Angeles, USA, and colleagues aimed to assess the relation between HIV-1 shedding (RNA or culturable virus) in female genital secretions and other factors that might affect HIV-1 shedding.

311 HIV positive women were enrolled in the study from five centres in the USA. The investigators did clinical assessments, cultured HIV-1, and measured RNA in blood and genital secretions. Presence of HIV-1 RNA or culturable virus in genital secretions was defined as HIV-1 shedding.

HIV-1 RNA was present in genital secretions of 57% (152/268) of women whereas infectious virus was detected only in 6% (17/271). Genital tract HIV-1 shedding was found in 80% (130/163) of women with detectable plasma RNA and 78% (116/148) of women with positive peripheral blood mononuclear cells (PBMC) cultures. 33% (27/83) of women with low or undetectable (less than 500 copies/mL) plasma RNA and 39% (35/90) of those with negative PBMC cultures also had genital tract shedding.

Andrea Kovacs comments: "Concentration and presence of plasma HIV-1 RNA was the most significant factor in predicting HIV-1 shedding. This information might be useful in the future for monitoring patients receiving antiretroviral therapy, and counselling patients about transmission risk to a sexual partner or to a newborn infant."

In an accompanying Commentary (p 1564), Pietro Vernazza from Cantonal Hospital, St Gallen, Switzerland, concludes: "What Kovacs and colleagues' study indicates is that women in whom HAART [highly-active antiretroviral therapy] has suppressed HIV-1 concentrations in the blood might still have high concentrations of HIV-1 in the genital tract. The lack of an association between genital inflammation and viral shedding in multivariate analysis does not rule out the possibility that genital inflammation might account for the unusually high genital HIV-RNA concentrations in a few selected cases. Thus patients will have to continue to be warned about the consequences of unprotected sex even if blood tests indicate that they have responded to antiretroviral therapy."
Contact: Dr Andrea Kovacs, Maternal-Child and Adolescent HIV Management and Research Center, Keck School of Medicine of the University of Southern California, 1640 Marengo Street 3rd Floor, Los Angeles CA 90033, USA; T) +1 323 226 6447; F) +1 323 226 8362; E) akovacs@hsc.usc.edu

Dr Pietro L Vernazza, Division of Infectious Diseases, Department of Medicine, Cantonal Hospital , 9007 St Gallen, Switzerland; T) +41 71 494 1028; F) +41 71 494 6114; E) Pietro.Vernazza@kssg.ch


Related HIV Articles from Brightsurf:

BEAT-HIV Delaney collaboratory issues recommendations measuring persistent HIV reservoirs
Spearheaded by Wistar scientists, top worldwide HIV researchers from the BEAT-HIV Martin Delaney Collaboratory to Cure HIV-1 Infection by Combination Immunotherapy (BEAT-HIV Collaboratory) compiled the first comprehensive set of recommendations on how to best measure the size of persistent HIV reservoirs during cure-directed clinical studies.

The Lancet HIV: Study suggests a second patient has been cured of HIV
A study of the second HIV patient to undergo successful stem cell transplantation from donors with a HIV-resistant gene, finds that there was no active viral infection in the patient's blood 30 months after they stopped anti-retroviral therapy, according to a case report published in The Lancet HIV journal and presented at CROI (Conference on Retroviruses and Opportunistic Infections).

Children with HIV score below HIV-negative peers in cognitive, motor function tests
Children who acquired HIV in utero or during birth or breastfeeding did not perform as well as their peers who do not have HIV on tests measuring cognitive ability, motor function and attention, according to a report published online today in Clinical Infectious Diseases.

Efforts to end the HIV epidemic must not ignore people already living with HIV
Efforts to prevent new HIV transmissions in the US must be accompanied by addressing HIV-associated comorbidities to improve the health of people already living with HIV, NIH experts assert in the third of a series of JAMA commentaries.

The Lancet HIV: Severe anti-LGBT legislations associated with lower testing and awareness of HIV in African countries
This first systematic review to investigate HIV testing, treatment and viral suppression in men who have sex with men in Africa finds that among the most recent studies (conducted after 2011) only half of men have been tested for HIV in the past 12 months.

The Lancet HIV: Tenfold increase in number of adolescents on HIV treatment in South Africa since 2010, but many still untreated
A new study of more than 700,000 one to 19-year olds being treated for HIV infection suggests a ten-fold increase in the number of adolescents aged 15 to 19 receiving HIV treatment in South Africa, according to results published in The Lancet HIV journal.

Starting HIV treatment in ERs may be key to ending HIV spread worldwide
In a follow-up study conducted in South Africa, Johns Hopkins Medicine researchers say they have evidence that hospital emergency departments (EDs) worldwide may be key strategic settings for curbing the spread of HIV infections in hard-to-reach populations if the EDs jump-start treatment and case management as well as diagnosis of the disease.

NIH HIV experts prioritize research to achieve sustained ART-free HIV remission
Achieving sustained remission of HIV without life-long antiretroviral therapy (ART) is a top HIV research priority, according to a new commentary in JAMA by experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health.

The Lancet HIV: PrEP implementation is associated with a rapid decline in new HIV infections
Study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men.

Researchers date 'hibernating' HIV strains, advancing BC's leadership in HIV cure research
Researchers have developed a novel way for dating 'hibernating' HIV strains, in an advancement for HIV cure research.

Read More: HIV News and HIV Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.