1. Changes in HIV-1 Subtypes B and C Genital Tract RNA in Women and Men After Initiation of Antiretroviral Therapy
- Author
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Robert W. Coombs, Susan Cu-Uvin, Susan H. Eshleman, Irving F. Hoffman, Jonathan Uy, Donna Mildvan, David W. Haas, Thomas B. Campbell, Kelly Burke, David D. Celentano, Edith Swann, Ronald T. Mitsuyasu, Ann C. Collier, Beatriz Grinsztejn, Newton Kumwenda, Laurie Frarey, Breno Santos, Apsara Nair, Ann Walawander, David Chilongozi, Bartolo Santos, Taha E. Taha, Chiedza Maponga, Sima Berendes, S. Poongulali, M. P. Revuelta, Charles van der Horst, Robert C. Bollinger, Suniti Solomon, Jorge Sanchez, Francis Martinson, N. Kumarasamy, Joan Dragavon, James Hakim, Rosa Infante, Richard B. Pendame, Farida Amod, Roy M. Gulick, Jody Lawrence, P. Jan Geiseler, Joan Gormley, Judith S. Currier, Cynthia Firnhaber, Laura Moran, Larisa Zifchak, Myron S. Cohen, Keith A. Pappa, Beverly Putnam, Charles Flexner, David H. Haas, Sandra W. Cardoso, Karin L. Klingman, Ruben Lopez, Joel E. Gallant, James F. Rooney, Jabin Sharma, Edde Loeliger, Pablo Tebas, Beverly E. Sha, Barbara Brizz, Wendy Snowden, Scott M. Hammer, Johnstone Kumwenda, Javier R. Lama, Karin Nielsen, Christine Wanke, Steve Tabet, Alberto La Rosa, Wadzanai Samaneka, Joseph J. Eron, Michael K. Klebert, Renard S. Descallar, Bharat Ramratnam, Kenneth H. Mayer, Cheryl Marcus, Yvonne J. Bryson, Nikki Gettinger, Vicki L. Bailey, Adriana Andrade, David Shugarts, Robert T. Schooley, Ken Braun, David Currin, Eric S. Daar, Michael Hughes, Laura M. Smeaton, Vladimir Berthaud, Sharlaa Badal-Faesen, Victor De Gruttola, Cecelia Kanyama, Timothy P. Flanigan, Mark A. Winters, Yvette Delph, Smanga Ntshele, Peter N. Kazembe, Deise Lucia Faria, Mina C. Hosseinipour, Steven A. Safren, Ronald L. Barnett, Ana Martinez, Abel Tilahun Eshete, Beth D. Mullan, Henry H. Balfour, Ge-Youl Kim, Anthony Chisada, Yajing Bao, Ian Sanne, Virginia Kayoyo, Susan A. Fiscus, Janice M. Fritsche, and Nancy Webb
- Subjects
Adult ,Male ,Microbiology (medical) ,Cart ,medicine.medical_specialty ,Sexual transmission ,viruses ,HIV Infections ,Genitalia, Male ,Gastroenterology ,law.invention ,Plasma ,Randomized controlled trial ,law ,Internal medicine ,Blood plasma ,Humans ,Medicine ,business.industry ,virus diseases ,RNA ,Genitalia, Female ,Viral Load ,Antiretroviral therapy ,Infectious Diseases ,Anti-Retroviral Agents ,Genital tract ,Immunology ,HIV-1 ,HIV/AIDS ,RNA, Viral ,Female ,business ,Viral load - Abstract
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.
- Published
- 2013
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