News Release

Female genital shedding of HIV-1 poses infection risk

Peer-Reviewed Publication

The Lancet_DELETED

N.B. Please note that if you are outside North America the embargo for Lancet press material is 0001 hours UK time Friday 9 November 2001.

A study in this week’s issue of THE LANCET suggests that heterosexual women with HIV-1-including those who have had successful antiretroviral therapy-are at risk of transmitting HIV to their sexual partners and newborn infants as a result of viral shedding in the genital tract.

Plasma HIV-1 RNA concentration has been the best predictor for risk of heterosexual and perinatal transmission. However, direct contact with HIV-1 present locally in the genital tract might be necessary for transmission. Andrea Kovacs, from the Keck School of Medicine of the University of Southern California, Los Angeles, USA, and colleagues aimed to assess the relation between HIV-1 shedding (RNA or culturable virus) in female genital secretions and other factors that might affect HIV-1 shedding.

311 HIV positive women were enrolled in the study from five centres in the USA. The investigators did clinical assessments, cultured HIV-1, and measured RNA in blood and genital secretions. Presence of HIV-1 RNA or culturable virus in genital secretions was defined as HIV-1 shedding.

HIV-1 RNA was present in genital secretions of 57% (152/268) of women whereas infectious virus was detected only in 6% (17/271). Genital tract HIV-1 shedding was found in 80% (130/163) of women with detectable plasma RNA and 78% (116/148) of women with positive peripheral blood mononuclear cells (PBMC) cultures. 33% (27/83) of women with low or undetectable (less than 500 copies/mL) plasma RNA and 39% (35/90) of those with negative PBMC cultures also had genital tract shedding.

Andrea Kovacs comments: “Concentration and presence of plasma HIV-1 RNA was the most significant factor in predicting HIV-1 shedding. This information might be useful in the future for monitoring patients receiving antiretroviral therapy, and counselling patients about transmission risk to a sexual partner or to a newborn infant.”

In an accompanying Commentary (p 1564), Pietro Vernazza from Cantonal Hospital, St Gallen, Switzerland, concludes: “What Kovacs and colleagues’ study indicates is that women in whom HAART [highly-active antiretroviral therapy] has suppressed HIV-1 concentrations in the blood might still have high concentrations of HIV-1 in the genital tract. The lack of an association between genital inflammation and viral shedding in multivariate analysis does not rule out the possibility that genital inflammation might account for the unusually high genital HIV-RNA concentrations in a few selected cases. Thus patients will have to continue to be warned about the consequences of unprotected sex even if blood tests indicate that they have responded to antiretroviral therapy.”

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Contact: Dr Andrea Kovacs, Maternal-Child and Adolescent HIV Management and Research Center, Keck School of Medicine of the University of Southern California, 1640 Marengo Street 3rd Floor, Los Angeles CA 90033, USA; T) +1 323 226 6447; F) +1 323 226 8362; E) akovacs@hsc.usc.edu

Dr Pietro L Vernazza, Division of Infectious Diseases, Department of Medicine, Cantonal Hospital , 9007 St Gallen, Switzerland; T) +41 71 494 1028; F) +41 71 494 6114; E) Pietro.Vernazza@kssg.ch


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