Correlation of Human Immunodeficiency Virus Type 1 RNA Levels in Blood and the Female Genital Tract

Abstract

In this study, the correlations of human immunodeficiency virus type 1 (HIV-1) RNA levels in blood plasma, vaginal secretions, and cervical mucus of 52 HIV-1-infected women were determined. The amount of cell-free HIV-1 RNA in blood plasma was correlated with that in vaginal secretions (Spearman's rank correlation coefficient (r) = 0.64, P<.001). In both blood plasma and vaginal secretions, the amounts of cell-free and cell-associated HIV-1 RNA were highly correlated (r=0.76, P<.01 and r=0.85, P<.01, respectively). Cell-free HIV-1 RNA levels in blood plasma and vaginal secretions were negatively correlated with CD4+ T lymphocyte count (r=-0.44, P<.01 and r=-0.40, P<.01, respectively). Similar to the effect observed in blood plasma, initiation of antiretroviral therapy significantly reduced the amount of HIV-1 RNA in vaginal secretions. These findings suggest that factors that lower blood plasma virus load may also reduce the risk of perinatal and female-to-male heterosexual transmission by lowering vaginal virus load.

Virologic and Immunologic Determinants of Heterosexual Transmission of Human Immunodeficiency Virus Type 1 in Africa

“…[44][45][46] There is less consensus on the association between plasma viremia and male genital tract HIV-1 levels, where modest or no correlations have been reported. [47][48][49][50] Our data indicate that there are gender differences in the relationship between plasma viral load and transmission.…”

Diversity, Divergence, and Evolution of Cell-Free Human Immunodeficiency Virus Type 1 in Vaginal Secretions and Blood of Chronically Infected Women: Associations with Immune Status

“…HIV-infected women were asked to enroll in this study if they were 18 to 49 years of age, had a normal Pap smear within the previous 12 months, were expected to live at least 1 year, and either were not on antiretroviral therapy or had taken the same antiretroviral therapy for at least 3 months prior to enrollment. Exclusion criteria were as described elsewhere (30). Participants were requested to refrain from vaginal intercourse and the use of intravaginal medications for 72 h before their examinations.…”

“…At each clinical exam, lavage samples were obtained by introducing 10 ml of phosphate-buffered saline into the vagina and collecting the pooled fluid in the posterior vaginal fornix. Vaginal secretions were tested for the presence of seminal fluid, as described elsewhere (13,30). Endocervical swabs were obtained to culture Neisseria gonorrhoeae and to test for Chlamydia trachomatis.…”

“…Several studies found that cell-free virus levels in vaginal secretions are inversely correlated with CD4 ϩ cell levels in the blood of infected women (26,30,55), suggesting that a functioning immune system is associated with controlling viral replication in genital tissues. More recent evidence indicates that women with higher CD4 ϩ cell levels are more likely to have compartmentalized cell-free virus shed in their genital tract secretions (31).…”

Antenatal Screening and HIV-Pregnancy: Strategies for Treatment

“…Additionally, although HIV RNA may be an important risk factor for transmission, other factors also appear to play a role (Mock et al 1999). Although there is a general correlation between viral load in plasma and in the genital tract, discordance has also been reported, particularly between HIV proviral load in blood and genital secretions, especially in the presence of other genital tract infections (Hart et al 1999). The use of ARV drugs during pregnancy for prevention of PT should be discussed with and offered to all infected pregnant women regardless of their HIV RNA level.…”