Women with low levels of HIV in blood may still harbor virus in genital tract

November 08, 2001

HIV-positive women may risk transmitting HIV to sexual partners and new-born infants through virus released in the genital tract, even if blood levels of the virus are low, according to a study by a Keck School of Medicine of USC researcher and colleagues.

Heterosexual women with HIV-1--the type of HIV that accounts for most infections--apparently can expose others to the virus even when the women are thought to be on a successful regimen of antiretroviral drugs, the physicians report in the Nov. 10 issue of The Lancet.

Physicians know that measuring the concentration of HIV-1 RNA (the virus's telltale genetic material) in the blood is the best predictor of a woman's risk of transmitting HIV through heterosexual contact or during childbirth. However, direct contact with virus in the genital tract might be the necessary key to HIV transmission, according to Andrea Kovacs, M.D., associate professor of pediatrics and pathology at the Keck School.

Physicians at five centers across the nation enrolled 311 HIV-positive women for the study, analyzing samples of participants' blood and taking swabs and a sterile saline wash of the genital tract. They measured the level of detectable viral RNA in blood and from genital tissues, and made cultures from both sources, as well. (Viral cultures serve as a measure of the virus's infectious potential.)

Among the findings:
- HIV-1 RNA was found in genital secretions of 57 percent of the women; cultured infectious virus from genital secretions was found in 6 percent of the women.

- Among women with detectable viral RNA in their blood, 80 percent had HIV-1 shedding in their genital tract; among those who had positive virus cultures from their blood samples, 78 percent had HIV-1 shedding in their genital tract.

- About a third of women (33 percent) with low or undetectable RNA in their blood--and 39 percent of those whose blood cultures were negative for infectious virus--did have HIV-1 shed in the genital region. Consistent with previous smaller studies, the team found that the greater the concentration of RNA in the blood, the greater the concentration of HIV-1 in the genital tract.

"Concentration and presence of plasma HIV-1 RNA was the most significant factor in predicting HIV-1 shedding," said Kovacs, director of the Comprehensive Maternal-Child and Adolescent HIV Management and Research Center at LAC+USC Medical Center. "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 new-born infant."

But even women who had little virus evident in the blood still could release infectious HIV-1 from the cells of the uterus, cervix and surrounding tissues. "This suggests a separate reservoir of HIV-1 replication," Kovacs noted. The researchers propose that perhaps drugs' effects or drug levels may vary across tissues, allowing for more replication of the virus in tissues of the reproductive tract than in blood, for example. Research already has indicated that the female genital tract is a distinct environment, where HIV-1 replicates differently than in the blood.

"More research in clinical trials is needed to assess the impact of antiretroviral therapy and protease inhibitors on genital tract shedding, and on the virus's resistance to drugs in that region," Kovacs said.

Study participants were enrolled at sites in Los Angeles, San Francisco, Chicago, Washington, D.C. and Brooklyn, N.Y. The study was supported through the National Institute of Allergy and Infectious Diseases, the U.S. Department of Health and Human Services and the Women's Interagency HIV Study.
Andrea Kovacs, Steven S. Wasserman, David Burns, David J. Wright, Jonathan Cohn, Alan Landay, Kathleen Weber, Mardge Cohen, Alexandra Levine, Howard Minkoff, Paolo Miotti, Joel Palefsky, Mary Young, Patricia Reichelderfer and the DATRI and WIHS Study Groups, "Determinants of HIV-1 shedding in the genital tract of women." The Lancet, Vol. 358, No. 9293, Nov. 10, 2001, pp. 1593-1601.

University of Southern California

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.