Anderson Brenna L, Wang Chia-Ching, Delong Allison K, Liu Tao, Kojic Erna Milu, Kurpewski Jaclynn, Ingersoll Jessica, Mayer Kenneth, Caliendo Angela M, Cu-Uvin Susan
Department of Obstetrics and Gynecology, Women & Infants' Hospital, Providence, RI 02905, USA.
Clin Infect Dis. 2008 Nov 1;47(9):1216-21. doi: 10.1086/592303.
The mechanism of human immunodeficiency virus (HIV) transmission via heterosexual intercourse is unknown. We sought to determine whether the presence of inflammatory cells in the vagina is associated with the presence of genital tract HIV type 1 (HIV-1) RNA.
Analysis of a longitudinal prospective cohort was performed. Women with HIV-1 infection were assessed with use of paired plasma and cervicovaginal lavage specimens. Viral load measurements were performed using nucleic acid sequence-based amplification. White blood cells found in the genital tract (GT WBCs) were quantified using a hemacytometer. Common lower genital tract infections assessed for association with viral shedding (i.e., genital tract viral load [GTVL]) included bacterial vaginosis, candidiasis, and trichomoniasis. Generalized estimating equations were used to estimate the prevalence and odds of detectable GTVL by GT WBC. The association was examined both in the presence and in the absence of lower genital tract infections.
A total of 97 women and 642 visits were included in the analysis. Median duration of follow-up was 30.4 months. Thirty women (31%) had detectable GTVL at any visit. The median CD4 cell count at baseline was 525 cells/muL. Most women were antiretroviral therapy naive at baseline. After adjustment for plasma viral load, the odds of detectable GTVL increased as GT WBC increased, with an odds ratio of 1.36 (95% confidence interval, 1.1-1.7) per 1000-cell increase in GT WBC among women without lower genital tract infections. After adjustment for plasma viral load and lower genital tract infections by incorporating them in a regression model, GT WBC remained significantly associated with GTVL, with an adjusted odds ratio of 1.22 (95% confidence interval, 1.08-1.37).
The presence of GT WBC is associated with an increased risk of detectable GTVL.
人类免疫缺陷病毒（HIV）通过异性性行为传播的机制尚不清楚。我们试图确定阴道中炎症细胞的存在是否与生殖道1型HIV（HIV-1）RNA的存在有关。
对一个纵向前瞻性队列进行分析。对感染HIV-1的女性使用配对的血浆和宫颈阴道灌洗标本进行评估。使用基于核酸序列的扩增法进行病毒载量测量。使用血细胞计数器对生殖道中发现的白细胞（GT白细胞）进行定量。评估与病毒脱落（即生殖道病毒载量[GTVL]）相关的常见下生殖道感染包括细菌性阴道病、念珠菌病和滴虫病。使用广义估计方程来估计GT白细胞检测到可检测GTVL的患病率和比值比。在有和没有下生殖道感染的情况下都对这种关联进行了检查。
分析共纳入97名女性和642次就诊。中位随访时间为30.4个月。30名女性（31%）在任何一次就诊时都检测到可检测的GTVL。基线时CD4细胞计数的中位数为525个/微升。大多数女性在基线时未接受抗逆转录病毒治疗。在调整血浆病毒载量后，可检测GTVL的比值比随着GT白细胞的增加而增加，在没有下生殖道感染的女性中，GT白细胞每增加1000个细胞，比值比为1.36（95%置信区间，1.1 - 1.7）。在将血浆病毒载量和下生殖道感染纳入回归模型进行调整后，GT白细胞仍与GTVL显著相关，调整后的比值比为1.22（95%置信区间，1.08 - 1.37）。
GT白细胞的存在与可检测GTVL风险增加有关。
