Injectable Contraceptive Use and Genital Ulcer Disease during the Early Phase of HIV‐1 Infection Increase Plasma Virus Load in Women

We examined the association between host factors present near the time of human immunodeficiency virus type 1 (HIV-1) acquisition and subsequent virus loads in a prospective cohort study of women in Mombasa Kenya. Women were prospectively followed monthly before HIV-1 infection. One hundred sixty-one commercial sex workers who became infected with HIV-1 were followed for a median of 34 months and 991 plasma samples collected =4 months after infection were tested for HIV-1 RNA. The median virus set point at 4 months after infection was 4.46 log/10 copies/mL and the average virus load increase during subsequent follow-up was 0.0094 log/10 copies/mL/month. In a multivariate analysis that controlled for sexual behavior the use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) at the time of HIV-1 infection was associated with a higher virus set point and the presence of genital ulcer disease (GUD) during the early phase of HIV-1 infection was associated with greater change in virus load during follow-up. These findings suggest that in women the use of DMPA and the presence of GUD during the early phase of HIV- 1 infection may influence the natural course of infection. (authors)