Vaginal Cytomegalovirus Shedding Before and After Initiation of Antiretroviral Therapy in Rakai, Uganda

Abstract

Vaginal shedding of cytomegalovirus (CMV) DNA was determined longitudinally among 96 women coinfected with human immunodeficiency virus (HIV), herpes simplex virus 2, and CMV starting antiretroviral therapy (ART) during a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Vaginal CMV was detected in 75 of 96 women (78.0%) and 379 of 1080 individual visits (35.1%). ART status, higher HIV RNA viral load before ART initiation, and younger age were significantly associated with increased frequency of CMV shedding (P < .01). Compared to pre-ART, CMV shedding peaked from month 2 to month 4 after ART initiation, suggesting possible immune reconstitution inflammatory syndrome. Further studies need to determine the clinical significance of asymptomatic CMV shedding.

Keywords: Uganda; acyclovir; antiretroviral therapy (ART); cytomegalovirus (CMV); human immunodeficiency virus (HIV); immune reconstitution inflammatory syndrome (IRIS); reactivation.

Figure 1.

The probability of having a detectable CMV DNA in vaginal swab by monthly study visit is shown. ART initiation is indicated with red dashed line. Prevalence of CMV DNA shedding significantly increased after initiation of ART. Months post-ART initiation with significantly higher shedding compared to all pre-ART visits are indicated with an asterisk (*). Abbreviations: ART, antiretroviral therapy; CMV, cytomegalovirus.