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Randomized Controlled Trial
. 2013 Jul;57(2):290-7.
doi: 10.1093/cid/cit195. Epub 2013 Mar 26.

Changes in HIV-1 subtypes B and C genital tract RNA in women and men after initiation of antiretroviral therapy

Susan A Fiscus  1 , Susan Cu-Uvin, Abel Tilahun Eshete, Michael D Hughes, Yajing Bao, Mina Hosseinipour, Beatriz Grinsztejn, Sharlaa Badal-Faesen, Joan Dragavon, Robert W Coombs, Ken Braun, Laura Moran, James Hakim, Timothy Flanigan, N Kumarasamy, Thomas B Campbell; A5185s Team
Collaborators, Affiliations
Randomized Controlled Trial

Changes in HIV-1 subtypes B and C genital tract RNA in women and men after initiation of antiretroviral therapy

Susan A Fiscus et al. Clin Infect Dis. 2013 Jul.

Abstract

Background: Combination antiretroviral therapy (cART) reduces genital tract human immunodeficiency virus type 1 (HIV-1) load and reduces the risk of sexual transmission, but little is known about the efficacy of cART for decreasing genital tract viral load (GTVL) and differences in sex or HIV-1 subtype.

Methods: HIV-1 RNA from blood plasma, seminal plasma, or cervical wicks was quantified at baseline and at weeks 48 and 96 after entry in a randomized clinical trial of 3 cART regimens.

Results: One hundred fifty-eight men and 170 women from 7 countries were studied (men: 55% subtype B and 45% subtype C; women: 24% subtype B and 76% subtype C). Despite similar baseline CD4(+) cell counts and blood plasma viral loads, women with subtype C had the highest GTVL (median, 5.1 log10 copies/mL) compared to women with subtype B and men with subtype C or B (4.0, 4.0, and 3.8 log10 copies/mL, respectively; P < .001). The proportion of participants with a GTVL below the lower limit of quantification (LLQ) at week 48 (90%) and week 96 (90%) was increased compared to baseline (16%; P < .001 at both times). Women were significantly less likely to have GTVL below the LLQ compared to men (84% vs 94% at week 48, P = .006; 84% vs 97% at week 96, P = .002), despite a more sensitive assay for seminal plasma than for cervical wicks. No difference in GTVL response across the 3 cART regimens was detected.

Conclusions: The female genital tract may serve as a reservoir of persistent HIV-1 replication during cART and affect the use of cART to prevent sexual and perinatal transmission of HIV-1.

Keywords: HIV-1 genital tract RNA; HIV-1 subtypes B and C; antiretroviral drugs.

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Figures

Figure 1.
Figure 1.
Proportion of participants with genital tract and blood plasma human immunodeficiency virus type 1 (HIV-1) RNA levels below the assay lower limit of quantification by weeks after starting antiretroviral therapy by sex/HIV-1 subtype. Abbreviations: HIV-1, human immunodeficiency virus type 1; LLQ, lower limit of quantification.
See this image and copyright information in PMC

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