Coleman Jenell S, Hitti Jane, Bukusi Elizabeth A, Mwachari Christina, Muliro Angela, Nguti Rosemary, Gausman Reggie, Jensen Sarah, Patton Dorothy, Lockhart David, Coombs Robert, Cohen Craig R
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94105, USA.
AIDS. 2007 Mar 30;21(6):755-9. doi: 10.1097/QAD.0b013e328012b838.
To determine the effects of vaginal, cervical, and endometrial infections on shedding of HIV-1 RNA in the female genital tract.
Cross-sectional.
Antiretroviral-naive women from Nairobi, Kenya with CD4 cell counts >or= 350 cells/mul had plasma and endocervical wick samples collected for HIV quantification by real-time RNA reverse transcriptase-polymerase chain reaction. Vaginal and cervical Gram stains and endometrial biopsies were obtained. Vaginal Gram stain was used to diagnose bacterial vaginosis and to quantify Lactobacillus levels.
Twenty-six of 50 (52%) women had detectable endocervical HIV-1 RNA with a median endocervical viral load of 1760 copies/ml (range: undetectable to 1 1,030,000 copies/ml). Women with decreased Lactobacillus had 15.8-fold [95% confidence interval (CI), 2.0-123] greater endocervical HIV-1 RNA than women with normal Lactobacillus levels. Women with plasma cell (PC) endometritis [>or= 1 PC/high-power field (hpf)] had a 15.8-fold (95% CI, 2.0-120) higher endocervical HIV RNA level than women without PC endometritis. Both these associations remained after controlling for plasma viral load. Cervicitis (>or= 30 polymorphonuclear leukocytes/hpf), however, was not associated with endocervical HIV-1 RNA shedding (P = 0.81).
In HIV-1-infected, antiretroviral-naive women without symptoms of pelvic inflammatory disease infection, abnormal vaginal flora and inflammatory cells in the endometrium affected HIV-1 shedding from the lower genital tract. These data suggest that both the upper and lower genital tracts contribute to female HIV-1 genital shedding.
确定阴道、宫颈和子宫内膜感染对女性生殖道中HIV-1 RNA脱落的影响。
横断面研究。
来自肯尼亚内罗毕的未接受抗逆转录病毒治疗、CD4细胞计数≥350个/μl的女性，采集血浆和宫颈棉拭子样本，通过实时RNA逆转录-聚合酶链反应进行HIV定量检测。获取阴道和宫颈革兰氏染色及子宫内膜活检样本。阴道革兰氏染色用于诊断细菌性阴道病并量化乳酸杆菌水平。
50名女性中有26名（52%）宫颈可检测到HIV-1 RNA，宫颈病毒载量中位数为1760拷贝/ml（范围：未检测到至11030000拷贝/ml）。乳酸杆菌数量减少的女性宫颈HIV-1 RNA水平比乳酸杆菌水平正常的女性高15.8倍[95%置信区间（CI），2.0 - 123]。患有浆细胞（PC）性子宫内膜炎[≥1个PC/高倍视野（hpf）]的女性宫颈HIV RNA水平比无PC性子宫内膜炎的女性高15.8倍（95% CI，2.0 - 120）。在控制血浆病毒载量后，这两种关联仍然存在。然而，宫颈炎（≥30个多形核白细胞/hpf）与宫颈HIV-1 RNA脱落无关（P = 0.81）。
在未感染抗逆转录病毒药物、无盆腔炎性疾病感染症状的HIV-1感染女性中，异常的阴道菌群和子宫内膜中的炎性细胞影响了HIV-1从下生殖道的脱落。这些数据表明，上生殖道和下生殖道都对女性HIV-1生殖道脱落有影响。
