Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding.
Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding.
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DOI：
10.1097/qai.0b013e31824aeaaa
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发表时间：
2012-05-01
期刊：
影响因子：
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通讯作者：
Kovacs A
中科院分区：
文献类型：
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作者：
Homans J;Christensen S;Stiller T;Wang CH;Mack W;Anastos K;Minkoff H;Young M;Greenblatt R;Cohen M;Strickler H;Karim R;Spencer LY;Operskalski E;Frederick T;Kovacs A
宫颈阴道艾滋病毒水平(CV-VL)影响艾滋病毒传播。血浆病毒载量(PVL)与CV-VL相关，但经常不一致。我们评估了PVL、行为、免疫和局部因素/条件是如何单独和共同地与CV-VL相关的。在一项纵向队列研究中，对481名HIV感染妇女进行了超过976人次的宫颈阴道灌洗液(CVL)中CV-VL的检测。采用单因素和多因素线性回归分析方法，对13 6例≥3次就诊的患者进行单因素和多因素线性回归分析，确定相关因素与≥3次就诊的CV-VL和可检测/不可检测PVL层数的关系，并与剥离方式(从未、间断、持续性PVL 3次就诊)进行有序Logistic回归分析。450/959人次(46.9%)与可供选择的PVL不一致。435/959例(45.3%)PVL可检出伴CVVL未检出，15/959例(1.6%)PVL未检出伴CV-VL。较低的CV-VL与HAART使用率相关(P=0.01)。较高的CV-VL与较高的PVL(P<0.001)、炎症相关细胞改变(P=0.03)、宫颈异位(P=0.009)、渗出液(P=0.005)和滴虫感染(P=0.03)相关。在PVL可检出层的多因素分析中，CV-VL增加与相同的因素和易碎性相关(P=0.05)，而在PVL未检出的情况下，CV-VL降低与HAART的使用相关(P=0.04)。纵向分析中，以神经性(40.4%)和间歇性(44.9%)脱落最多见。高频率脱落者的初始PVL(OR=2.47/log10增加)、HSV-2血清阳性(OR=3.21)和饮酒(OR=2.20)更有可能。虽然PVL与CV-VL有很强的相关性，但不一致是常见的。当可检测到PVL时，宫颈阴道炎状况与脱落增加相关。然而，生殖器脱落是零星的，相关因素并不能可靠地预测。HAART通过减少PVL，是减少宫颈阴道脱落的最可靠的方法。
Cervicovaginal HIV level (CV-VL) influences HIV transmission. Plasma viral load (PVL) correlates with CV-VL but discordance is frequent. We evaluated how PVL, behavioral, immunologic and local factors/conditions individually and collectively correlate with CV-VL. CV-VL was measured in cervicovaginal lavage fluid (CVL) over 976 person-visits for 481 HIV-infected women in a longitudinal cohort study. We correlated identified factors with CV-VL at individual person-visits and detectable/undetectable PVL strata by univariate and multivariate linear regression, and with shedding pattern (never, intermittent, persistent ≥3 shedding-visits) in 136 women with ≥3 visits by ordinal logistic regression. 450/959 (46.9%) of person-visits with available PVL were discordant. 435/959 (45.3%) had detectable PVL with undetectable CV-VL and 15/959 (1.6%) undetectable PVL with detectable CV-VL. Lower CV-VL correlated with HAART usage (P=0.01). Higher CV-VL correlated with higher PVL (P<0.001), inflammation-associated cellular changes (P=0.03), cervical ectopy (P=0.009), exudate (P=0.005), and trichomoniasis (P=0.03). In multivariate analysis of the PVL-detectable stratum, increased CV-VL correlated with the same factors and friability (P=0.05), while with undetectable PVL, decreased CV-VL correlated with HAART use (P=0.04). In longitudinal analysis, never (40.4%) and intermittent (44.9%) shedding were most frequent. Higher-frequency shedders were more likely to have higher initial PVL (OR=2.47/log10 increase), HSV-2 seropositivity (OR=3.21) and alcohol use (OR=2.20). While PVL correlates strongly with CV-VL, discordance is frequent. When PVL is detectable, cervicovaginal inflammatory conditions correlate with increased shedding. However, genital shedding is sporadic and not reliably predicted by associated factors. HAART, by reducing PVL, is the most reliable means of reducing cervicovaginal shedding.