HIV-1 and herpes simplex virus type-2 genital shedding among co-infected women using self-collected swabs in Chiang Rai, Thailand

Abstract

We analysed 528 genital self-collected swabs (SCS) from 67 HIV-1 and herpes simplex virus type-2 (HSV-2) co-infected women collected during the placebo month of a randomized crossover clinical trial of suppressive acyclovir in Chiang Rai, Thailand. In this first longitudinal study of HIV-1 and HSV-2 co-infected women using genital SCS specimens, we found frequent mucosal HIV-1 shedding. Overall, 372 (70%) swabs had detectable HIV-1 RNA with median HIV-1 viral load of 2.61 log(10) copies/swab. We found no statistically significant association between detectable HIV-1 RNA and HSV-2 DNA in the same SCS specimen (adjusted odds ratio [aOR] 1.40; 95% confidence intervals [CI], 0.78-2.60, P = 0.25). Only baseline HIV-1 plasma viral load was independently associated with genital HIV-1 RNA shedding (aOR, 7.6; 95% CI, 3.3-17.2, P < 0.0001). SCS may be useful for future HIV-1 and HSV-2 studies because this method allows for frequent genital sampling, and inclusion of genital sites other than the cervix.

Comparison of sampling methods to measure HIV RNA viral load in female genital tract secretions

“…27,28 Of note, proportions of specimens with detectable HIV RNA at each visit are somewhat lower than previously reported among other cohorts including ART-naïve HIV-infected women. [29][30][31][32] The restriction of our cohort to women with CD4 counts >350 cells/mm 3 at enrollment, and there were few incident infections detected in this group. Two women had undetectable plasma viral load at all visits and all participants, including these two women, had documented positive HIV antibody testing at screening.…”

“…29–32 The restriction of our cohort to women with CD4 counts >350 cells/mm 3 and with recent RTI screening and treatment may have contributed to this observation. We treated all women with prevalent infection at screening, ideally reducing any contribution of RTIs to genital tract HIV shedding at enrollment, and there were few incident infections detected in this group.…”

Sexually transmitted infections among patients with herpes simplex virus at King Abdulaziz University Hospital

“…Furthermore, it was found that HIV positive patients who have genital ulcers are highly infectious due to HIV shedding from the ulcer site. These patients also tend to have high HIV viral loads [12,13]. Growing data is now describing the benefits of herpes suppression in individuals co-infected with HIV and HSV-2, as herpes suppression lowers HIV viral load even though it would not control HIV sexual transmission [12,14].…”

Self-collected genital swabs compared with cervicovaginal lavage for measuring HIV-1 and HSV-2 and the effect of acyclovir on viral shedding

“…At baseline, median CD4 count was 366 cells/ml, plasma HIV-1 viral load was 4.6 log 10 copies/ml, and baseline plasma viral load was associated with HIV-1 shedding in SCS. 18 Women did not receive ART during the trial. They received acyclovir or placebo the first month, no product the second month, and crossed over to placebo or acyclovir the third month.…”

“…8 This sample required a weekly clinic visit and collection by a physician or other trained provider. During the trial, self-collected genital swabs (SCS) were also obtained 18 to allow comparison with CVL. Although CVL have the advantage of a larger sample volume than swabs, some studies have shown equal or higher HIV-1 detection rates with cervical or endocervical swabs.…”