UNC Center for AIDS Research Department of Microbiology and Immunology Department of Medicine Department of Biochemistry and Biophysics, School of Medicine Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Departments of Pediatrics and Microbiology-Immunology Department of Medicine, Albert Einstein College of Medicine, Bronx Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York Division of Infectious Diseases and Travel Medicine, Georgetown University, Washington, DC Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California The Core Center, Cook County Health and Hospital System, Rush University Medical College, Chicago, Illinois Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
AIDS. 2020 Jan 1;34(1):39-46. doi: 10.1097/QAD.0000000000002373.
Determine the frequency of genital HIV-1 shedding in a large cohort of women on long-term suppressive antiretroviral therapy (ART) and its association with mucosal inflammation.
We measured levels of HIV-1 RNA and inflammation biomarkers in cervicovaginal lavage (CVL) from HIV-seropositive women enrolled in the Women's Interagency HIV Study (WIHS).
HIV-1 was quantified (Abbott RealTime HIV-1 assay) from CVL samples of 332 WIHS participants with and without clinical evidence of genital inflammation at the time of CVL collection; participants had suppressed plasma viral load (PVL; limit of quantitation less than 20-4000 copies/ml depending on year of collection) for a median of 7.1 years [interquartile range (IQR) 3.4-9.8, Group 1] or for a median of 1.0 years (IQR = 0.5-1.0, Group 2). Twenty-two biomarkers of inflammation were measured in CVL to compare with clinical markers.
HIV-1 was detected in 47% of 38 pre-ART CVL samples (median 668 copies/ml) and detection in CVL was associated with higher pre-ART PVL. HIV-1 was detected in only 1 of 38 CVL samples from these women on suppressive antiretroviral therapy for 1 year. No HIV-1 RNA was detected in 294 CVL samples from a cross-sectional set of women with suppressed PVL for a median of 7 years. Clinical inflammation markers were correlated with inflammatory biomarkers in CVL specimens, although genital inflammation was not associated with measurable genital HIV-1 shedding in these WIHS participants on ART.
ART that suppresses HIV-1 in the plasma of women also prevents genital tract HIV-1 shedding, even in the presence of genital tract inflammation.
在长期接受抑制性抗逆转录病毒疗法（ART）的大量女性队列中，确定生殖器 HIV-1 脱落的频率及其与黏膜炎症的关系。
我们测量了艾滋病毒血清阳性的妇女参加妇女机构间艾滋病毒研究（WIHS）时从宫颈阴道灌洗（CVL）中 HIV-1 RNA 和炎症生物标志物的水平。
从 332 名 WIHS 参与者的 CVL 样本中定量 HIV-1（Abbott RealTime HIV-1 测定），这些参与者在 CVL 采集时具有或不具有生殖器炎症的临床证据；参与者的血浆病毒载量（PVL）得到抑制（定量下限根据采集年份在 20-4000 拷贝/ml 之间），中位数为 7.1 年（四分位距 [IQR] 3.4-9.8，第 1 组）或中位数为 1.0 年（IQR=0.5-1.0，第 2 组）。为了与临床标志物进行比较，在 CVL 中测量了 22 种炎症生物标志物。
在 38 个预 ART CVL 样本中的 47%（中位数为 668 拷贝/ml）中检测到 HIV-1，CVL 中的检测与较高的预 ART PVL 相关。在接受抑制性抗逆转录病毒治疗 1 年的这些女性的 38 个 CVL 样本中，仅在 1 个样本中检测到 HIV-1 RNA。在抑制性 PVL 中位数为 7 年的 294 个 CVL 样本中，未检测到 HIV-1 RNA。临床炎症标志物与 CVL 标本中的炎症生物标志物相关，尽管在这些接受 ART 的 WIHS 参与者中，生殖器炎症与可测量的生殖器 HIV-1 脱落无关。
抑制女性血浆中 HIV-1 的 ART 也可防止生殖道 HIV-1 脱落，即使在存在生殖道炎症的情况下。
