Changes in HIV-1 subtypes B and C genital tract RNA in women and men after initiation of antiretroviral therapy
Citation: Fiscus SA, Cu-Uvin S, Eshete AT, Hughes MD, Bao Y, Hosseinipour M, Grinsztejn B, Badal-Faesen S, Dragavon J, Coombs RW, Braun K, Moran L, Hakim J, Flanigan T, Kumarasamy N, Campbell TB; A5185s Team. Changes in HIV-1 subtypes B and C genital tract RNA in women and men after initiation of antiretroviral therapy. Clin Infect Dis. 2013 Jul;57(2):290-7. doi: 10.1093/cid/cit195. Epub 2013 Mar 26. PMID: 23532477; PMCID: PMC3689341
Access full article:
https://www.ncbi.nlm.nih.gov/pubmed/23532477
BACKGROUND:
Combination antiretroviral therapy (cART) reduces genital tract human immunodeficiency virus type 1 (HIV-1) load and reduces the risk of sexual transmission, but little is known about the efficacy of cART for decreasing genital tract viral load (GTVL) and differences in sex or HIV-1 subtype.
METHODS:
HIV-1 RNA from blood plasma, seminal plasma, or cervical wicks was quantified at baseline and at weeks 48 and 96 after entry in a randomized clinical trial of 3 cART regimens.
RESULTS:
One hundred fifty-eight men and 170 women from 7 countries were studied (men: 55% subtype B and 45% subtype C; women: 24% subtype B and 76% subtype C). Despite similar baseline CD4(+) cell counts and blood plasma viral loads, women with subtype C had the highest GTVL (median, 5.1 log10 copies/mL) compared to women with subtype B and men with subtype C or B (4.0, 4.0, and 3.8 log10 copies/mL, respectively; P < .001). The proportion of participants with a GTVL below the lower limit of quantification (LLQ) at week 48 (90%) and week 96 (90%) was increased compared to baseline (16%; P < .001 at both times). Women were significantly less likely to have GTVL below the LLQ compared to men (84% vs 94% at week 48, P = .006; 84% vs 97% at week 96, P = .002), despite a more sensitive assay for seminal plasma than for cervical wicks. No difference in GTVL response across the 3 cART regimens was detected.
CONCLUSIONS:
The female genital tract may serve as a reservoir of persistent HIV-1 replication during cART and affect the use of cART to prevent sexual and perinatal transmission of HIV-1.