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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31824aeaaa
Epidemiology and Prevention

Permissive and Protective Factors Associated With Presence, Level, and Longitudinal Pattern of Cervicovaginal HIV Shedding

Homans, James MD, MPH*; Christensen, Shawna MS*; Stiller, Tracey MS; Wang, Chia-Hao PhD; Mack, Wendy PhD*; Anastos, Kathryn MD§,∥; Minkoff, Howard MD; Young, Mary MD#; Greenblatt, Ruth MD**; Cohen, Mardge MD††; Strickler, Howard MD§,∥; Karim, Roksana MBBS, PhD; Spencer, LaShonda Yvette MD; Operskalski, Eva PhD; Frederick, Toinette PhD; Kovacs, Andrea MD

Supplemental Author Material


In the article by Homans et al, appearing in JAIDS: Journal of Acquired Immune Deficiency Syndromes, Vol. 60, No. 1, pp. 99-110, entitled “Permissive and Protective Factors Associated With Presence, Level, and Longitudinal Pattern of Cervicovaginal HIV Shedding”, an author affiliation was indicated incorrectly. For the author James Homans, the correct affiliation is: Maternal, Child and Adolescent Center for Infectious Diseases and Virology, Department of Pediatrics, Division of Infectious Disease, University of Southern California Keck School of Medicine, Los Angeles, CA.

JAIDS Journal of Acquired Immune Deficiency Syndromes. 60(3):e106, July 1, 2012.

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Background: Cervicovaginal HIV level (CV-VL) influences HIV transmission. Plasma viral load (PVL) correlates with CV-VL, but discordance is frequent. We evaluated how PVL, behavioral, immunological, and local factors/conditions individually and collectively correlate with CV-VL.

Methods: CV-VL was measured in the cervicovaginal lavage fluid (CVL) of 481 HIV-infected women over 976 person-visits in a longitudinal cohort study. We correlated identified factors with CV-VL at individual person-visits and detectable/undetectable PVL strata by univariate and multivariate linear regression and with shedding pattern (never, intermittent, persistent ≥3 shedding visits) in 136 women with ≥3 visits by ordinal logistic regression.

Results: Of 959 person-visits, 450 (46.9%) with available PVL were discordant, 435 (45.3%) had detectable PVL with undetectable CV-VL, and 15 (1.6%) had undetectable PVL with detectable CV-VL. Lower CV-VL correlated with highly active antiretroviral therapy (HAART) usage (P = 0.01). Higher CV-VL correlated with higher PVL (P < 0.001), inflammation-associated cellular changes (P = 0.03), cervical ectopy (P = 0.009), exudate (P = 0.005), and trichomoniasis (P = 0.03). In multivariate analysis of the PVL-detectable stratum, increased CV-VL correlated with the same factors and friability (P = 0.05), while with undetectable PVL, decreased CV-VL correlated with HAART use (P = 0.04). In longitudinal analysis, never (40.4%) and intermittent (44.9%) shedding were most frequent. Higher frequency shedders were more likely to have higher initial PVL [odds ratio (OR) = 2.47/log10 increase], herpes simplex virus type 2 seropositivity (OR = 3.21), and alcohol use (OR = 2.20).

Conclusions: Although PVL correlates strongly with CV-VL, discordance is frequent. When PVL is detectable, cervicovaginal inflammatory conditions correlate with increased shedding. However, genital shedding is sporadic and not reliably predicted by associated factors. HAART, by reducing PVL, is the most reliable means of reducing cervicovaginal shedding.

© 2012 Lippincott Williams & Wilkins, Inc.


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