HIV, Cervico Cancer and Seeking Treatment Services; Lessons from Burkina Faso

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Cervico-vaginal HIV-1 shedding in women taking antiretroviral therapy in Burkina Faso: A longitudinal study

Low, Andrea J. MD, PhD; Konate, Issouf MD; Nagot, Nicolas MD, PhD; Weiss, Helen A. PhD; Kania, Dramane PharmD; Vickerman, Peter PhD; Segondy, Michel PhD; Mabey, David MD, PhD; Pillay, Deenan MD; Meda, Nicolas MD; van de Perre, Philippe MD, PhD; Mayaud, Philippe MD.

Published Ahead-of-Print
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Abstract

Background: Antiretroviral therapy (ART) reduces transmission of HIV-1. However, genital HIV-1 can be detected in patients on ART. We analyzed factors associated with genital HIV-1 shedding among high-risk women on ART in Burkina Faso.
Methods: Plasma (PVL) and enriched cervico-vaginal lavage HIV-1 RNA were measured every 3-6 months for up to 8 years. Random-effects logistic and linear regression models were used to analyze associations of frequency and quantity of genital HIV-1 RNA with behavioral and biological factors, adjusting for within-woman correlation. The lower limit of detection of HIV-1 RNA in plasma and eCVL samples was 300 copies/ml.
Results: 188 participants initiated ART from 2004 to 2011. PVL was detectable in 16% (171/1050) of visits, in 52% (90/174) of women. Cervico-vaginal HIV-1 RNA was detectable in 16% (128/798) of visits with undetectable plasma HIV-1 RNA, in 45% (77/170) of women. After adjusting for PVL, detectable cervico-vaginal HIV-1 RNA was independently associated with abnormal vaginal discharge, and use of nevirapine or zidovudine vs. efavirenz and stavudine respectively; longer time on ART and hormonal contraception were not associated with increased shedding. The presence of bacterial vaginosis, Herpes Simplex Virus-2 (HSV-2) DNA, and the use of nevirapine vs efavirenz were independently associated with an increased quantity of cervico-vaginal HIV-1 RNA.
Conclusions: Certain ART regimens, abnormal vaginal discharge, bacterial vaginosis and genital HSV-2 are associated with HIV-1 cervico-vaginal shedding or quantity in women on ART after adjusting for PVL. This may reduce the effectiveness of ART as prevention in high-risk populations.
(C) 2013 by Lippincott Williams & Wilkins

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