Mostad S B, Overbaugh J, DeVange D M, Welch M J, Chohan B, Mandaliya K, Nyange P, Martin H L, Ndinya-Achola J, Bwayo J J, Kreiss J K
Department of Epidemiology, University of Washington, Seattle 98195, USA.
Lancet. 1997 Sep 27;350(9082):922-7. doi: 10.1016/S0140-6736(97)04240-2.
Factors that influence shedding of HIV-1 infected cells in cervical and vaginal secretions may be important determinants of sexual and vertical transmission of the virus. We investigated whether hormonal contraceptive use, vitamin A deficiency, and other variables were risk factors for cervical and vaginal shedding of HIV-infected cells.
Between December, 1994, and April, 1996, women who attended a municipal sexually transmitted diseases (STDs) clinic in Mombasa, Kenya, and had previously tested positive for HIV-1, were invited to take part in our cross-sectional study. Cervical and vaginal secretions from 318 women were evaluated for the presence of HIV-1 infected cells by PCR amplification of gag DNA sequences.
HIV-1 infected cells were detected in 51% of endocervical and 14% of vaginal-swab specimens. Both cervical and vaginal shedding of HIV-1 infected cells were highly associated with CD4 lymphocyte depletion (p = 0.00001 and p = 0.003, respectively). After adjustment for CD4 count, cervical proviral shedding was significantly associated with use of depot medroxyprogesterone acetate (odds ratio 2.9, 95% CI 1.5-5.7), and with use of low-dose and high-dose oral contraceptive pills (3.8, 1.4-9.9 and 12.3, 1.5-101, respectively). Vitamin A deficiency was highly predictive of vaginal HIV-1 DNA shedding. After adjustment for CD4 count, severe vitamin A deficiency, moderate deficiency, and low normal vitamin A status were associated with 12.9, 8.0, and 4.9-fold increased odds of vaginal shedding, respectively. Gonococcal cervicitis (3.1, 1.1-9.8) and vaginal candidiasis (2.6, 1.2-5.4) were also correlated with significant increases in HIV-1 DNA detection, but Chlamydia trachomatis and Trichomonas vaginalis were not.
Our study documents several novel correlates of HIV-1 shedding in cervical and vaginal secretions, most notably hormonal contraceptive use and vitamin A deficiency. These factors may be important determinants of sexual or vertical transmission of HIV-1 and are of public health importance because they are easily modified by simple interventions.
影响HIV-1感染细胞在宫颈和阴道分泌物中脱落的因素可能是该病毒性传播和垂直传播的重要决定因素。我们调查了使用激素避孕药、维生素A缺乏及其他变量是否为HIV感染细胞在宫颈和阴道脱落的危险因素。
在1994年12月至1996年4月期间，邀请肯尼亚蒙巴萨市一家市级性传播疾病（STD）诊所就诊且先前HIV-1检测呈阳性的女性参与我们的横断面研究。通过对gag DNA序列进行PCR扩增，评估318名女性的宫颈和阴道分泌物中是否存在HIV-1感染细胞。
在51%的宫颈管内膜和14%的阴道拭子标本中检测到HIV-1感染细胞。HIV-1感染细胞在宫颈和阴道的脱落均与CD4淋巴细胞耗竭高度相关（分别为p = 0.00001和p = 0.003）。在对CD4计数进行校正后，宫颈前病毒脱落与使用醋酸甲羟孕酮长效注射剂显著相关（比值比2.9，95%置信区间1.5 - 5.7），与使用低剂量和高剂量口服避孕药也显著相关（分别为3.8，1.4 - 9.9和12.3，1.5 - 101）。维生素A缺乏是阴道HIV-1 DNA脱落的高度预测指标。在对CD4计数进行校正后，严重维生素A缺乏、中度缺乏及维生素A水平略低于正常与阴道脱落几率分别增加12.9倍、8.0倍和4.9倍相关。淋菌性宫颈炎（3.1，1.1 - 9.8）和阴道念珠菌病（2.6，1.2 - 5.4）也与HIV-1 DNA检测显著增加相关，但沙眼衣原体和阴道毛滴虫则不然。
我们的研究记录了HIV-1在宫颈和阴道分泌物中脱落的几个新的相关因素，最显著的是使用激素避孕药和维生素A缺乏。这些因素可能是HIV-1性传播或垂直传播的重要决定因素，并且具有公共卫生重要性，因为它们可通过简单干预轻易改变。
