The Effect of Treatment of Vaginal Infections on Shedding of Human Immunodeficiency Virus Type 1

Abstract

To assess the effect of treatment of vaginal infections on vaginal shedding of cell-free human immunodeficiency virus type 1 (HIV-1) and HIV-1-infected cells, HIV-1-seropositive women were examined before and after treatment of Candida vulvovaginitis, Trichomonas vaginitis, and bacterial vaginosis. For Candida (n=98), vaginal HIV-1 RNA decreased from 3.36 to 2.86 log(10) copies/swab (P<.001), as did the prevalence of HIV-1 DNA (36% to 17%; odds ratio [OR], 2.8; 95% confidence interval [CI], 1.3-6.5). For Trichomonas vaginitis (n=55), HIV-1 RNA decreased from 3.67 to 3.05 log(10) copies/swab (P<.001), but the prevalence of HIV-1 DNA remained unchanged (22%-25%; OR, 0.8; 95% CI, 0.3-2.2). For bacterial vaginosis (n=73), neither the shedding of HIV-1 RNA (from 3.11 to 2.90 log(10) copies/swab; P=.14) nor the prevalence of DNA (from 21% to 23%; OR, 0.8; 95% CI, 0.3-2.0) changed. Vaginal HIV-1 decreased 3.2- and 4.2-fold after treating Candida and Trichomonas, respectively. These data suggest that HIV-1 transmission intervention strategies that incorporate diagnosis and treatment of these prevalent infections warrant evaluation.

Vulvovaginal Candidosis

“…An argument can be made for treating asymptomatic and recurrent vulvovaginal candidosis in HIVpositive women in whom candida has been confi rmed by microscopy because of the associated enhanced HIV vaginal shedding. Such treatment should theoretically reduce the risk of transmission of HIV (Wang et al, 2001).…”

Lower Genital Tract Infections in HIV-Infected Women: Can We Afford to Miss?

“…Many studies have shown an increase in HIV seroconversion associated with trichomonas infection [5][6][7]. Also among HIV-seropositive women, infection with Trichomonas vaginalis is associated with higher genital levels of HIV-1 and increased shedding of T. vaginalis in vaginal secretions, which decreased after treatment of trichomoniasis and with institution of ART [12][13][14].…”

Trichomonas vaginalis perturbs the junctional complex in epithelial cells

“…This parasite has a worldwide distribution and it infects 250 to 350 million people worldwide [2]. Trichomonose causes a serious discomfort to women, and is associated with adverse pregnancy outcome, manifested by preterm rupture of membranes, preterm delivery, and low-birth-weight infants [3,4], and infertility [5], cervical cancer [6,7], and increase in the transmission of human immunodeficiency virus [8][9][10]. Despite several advances that have been made in understanding the interaction between T. vaginalis and host cells, as well as in dissecting the steps in the invasion process [11], the cellular mechanisms of T. vaginalis pathogenesis are not well defined.…”