Presence of hepatitis C virus (HCV) RNA in the genital tracts of HCV/HIV-1-coinfected women

Abstract

Background: Hepatitis C virus (HCV)-infected women--in particular, those coinfected with human immunodeficiency virus type 1 (HIV-1)--can transmit infection to their children and sex partners.

Methods: The present study was conducted to analyze the presence of HCV RNA in cervicovaginal lavage (CVL) fluid from 71 women (58 HCV/HIV-1-coinfected women and 13 HCV-infected, HIV-1-uninfected women) enrolled in the Women's Interagency HIV Study.

Results: HCV RNA was detected (by a commercial polymerase chain reaction assay) in CVL fluid from 18 (29%) of the HIV-1-infected women and from none of the HIV-1-uninfected women (P<.05). Multivariate analysis revealed that risk factors for the presence of HCV RNA in CVL fluid were HCV viremia (odds ratio [OR], 16.81; P=.02) and HIV-1 RNA in CVL fluid (OR, 19.87; P=.02). This observation suggests local interactions between HIV-1 and HCV in the genital tract compartment. There was no correlation between HCV RNA in CVL fluid and CD4, CD8, or CD3 cell counts, HIV-1 RNA viremia, the number of leukocytes in CVL fluid, or HIV-1 therapy. Furthermore, in 3 of 5 analyzed patients who had a detectable CVL HCV RNA load, we found viral variants differing in the 5' untranslated region that were present neither in plasma nor in peripheral-blood mononuclear cells.

Conclusions: Our observations point to the importance of the genital tract compartment, in which local HCV replication could be facilitated by local HIV-1 replication.

Figure 1

Relationships between HIV-1 and hepatitis C virus (HCV) RNA loads in plasma and detectability of HCV RNA (A) and HIV-1 RNA (B) loads in cervicovaginal lavage (CVL) fluid. In the figure, circles indicate undetectable CVL HCV (A) or HIV-1 (B) loads, and triangles indicate detectable CVL HCV (A) or HIV-1 (B) loads. For the relationship between HIV-1 RNA load in CVL fluid and plasma, Pearson’s R = 0.50 (P = .0003); for the relationship between HCV RNA load in CVL fluid and plasma, Pearson’s R = 0.33 (P = .0111).

Figure 2

Single-strand conformation polymorphism analysis of plasma-, cervicovaginal lavage (CVL)–, and peripheral-blood mononuclear cell (PBMC)– derived 5′ untranslated region hepatitis C virus (HCV) sequences. CVL neg str, HCV RNA negative strand in CVL fluid.

Figure 3

Comparison of 5′ untranslated region hepatitis C virus (HCV) sequences amplified from plasma, cervicovaginal lavage (CVL) fluid, and peripheral-blood mononuclear cells (PBMCs) in patients 6, 7, and 9. In the figure, a minus sign indicates HCV RNA negative strand; “CVL” indicates the dominant variant; “CVL1,” “CVL2,” and “CVL3” indicate minor variants; and the nos. in parentheses indicate the no. of clones representing a given sequence.