Genital tract HIV-1 RNA shedding among women with below detectable plasma viral load
Genital tract HIV-1 RNA shedding among women with below detectable plasma viral load
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DOI：
10.1097/qad.0b013e32833e5043
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发表时间：
2010-10-23
期刊：
影响因子：
3.8
通讯作者：
Caliendo, Angela M.
中科院分区：
文献类型：
--
作者：
Cu-Uvin, Susan;DeLong, Allison K.;Caliendo, Angela M.
目的：很少有研究评估纵向生殖道 HIV-1 脱落情况。我们确定了接受抗逆转录病毒治疗后血浆病毒载量 (PVL) 受到抑制的女性的生殖道 HIV-1 RNA 随着时间推移的脱落模式。方法：每 4 周测量配对血浆和生殖道 HIV-1 RNA。参与者被分为持续性、间歇性或非脱落者。纵向分析检查了生殖道脱落率以及与 PVL、CD4 细胞计数和生殖道感染的关联。马尔可夫转换模型用于描述血浆和生殖道中 HIV-1 RNA 的动态，使用可检测和不可检测的 PVL 或生殖道 HIV-1 RNA 之间的每次访视转换。结果：59 名女性贡献了 582 次研究访视，其中 95% 和 98% 的基线 PVL 和生殖道病毒载量分别低于可检测水平。 59 名女性中有 32 名 (54%) 在生殖道中至少检测到一次 HIV-1 RNA。 59 名女性中有 22 名 (37%) 在研究访问期间可检测到生殖道 HIV-1 RNA，而 PVL 无法检测到； 6.8% 的女性为持续性脱毛者，31% 为间歇性脱毛者，45.8% 为非脱毛者。与对单个子区室进行采样相比，对三个子区室进行采样可以增加 HIV-1 生殖道病毒载量的检测。总体而言，约 13% 的就诊发生在任何子室中生殖道 HIV-1 RNA 脱落。当 PVL 检测不到时（95% 置信区间 6-14%），三个子区室中的至少一个出现脱落现象。结论：PVL 低于可检测水平的女性在人群水平上艾滋病毒性传播的风险可能较低，但在个体水平上可能继续具有传染性。 (C) 2010 年 Wolters Kluwer Health 垂直条 Lippincott Williams & Wilkins
Objective: Few studies have assessed longitudinal genital tract HIV-1 shedding. We determined patterns of genital tract HIV-1 RNA shedding over time among women with suppressed plasma viral load (PVL) on antiretroviral treatment.Methods: Paired plasma and genital tract HIV-1 RNA were measured every 4 weeks. Participants were classified as persistent, intermittent, or nonshedders. Longitudinal analysis examined rates of genital tract shedding and the association with PVL, CD4 cell count, and genital tract infections. Markov transition models were used to describe the dynamics of HIV-1 RNA in plasma and genital tract using visit-to-visit transitions from and to detectable and undetectable PVL or genital tract HIV-1 RNA.Results: Fifty-nine women contributed 582 study visits of whom 95 and 98% had below-detectable PVL and genital tract viral load, respectively, at baseline. Thirty-two of 59 women (54%) had detectable HIV-1 RNA at least once in the genital tract. Twenty-two of 59 (37%) women had detectable genital tract HIV-1 RNA during a study visit when PVL was undetectable; 6.8% of the women were persistent shedders, 31% were intermittent shedders, and 45.8% were nonshedders. Sampling three subcompartments increased detection of HIV-1 genital tract viral load compared to sampling a single subcompartment. Overall, genital tract HIV-1 RNA shedding in any subcompartment occurred at about 13% of visits. Shedding in at least one of the three subcompartments occurred at 9% of visits when PVL was undetectable (95% confidence interval 6-14%).Conclusion: Women with below-detectable PVL may have less risk of HIV sexual transmission on a population level, but may continue to be infectious on an individual level. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins