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Is There an Association Between HIV-1 Genital Shedding and Cervical Intraepithelial Neoplasia 2/3 Among Women on Antiretroviral Therapy?

Huchko, Megan Justine MD, MPH1; Woo, Victoria MD1; Liegler, Teri PhD2; Leddy, Anna BA1; Smith-McCune, Karen MD, PhD1; Sawaya, George F. MD1,3; Bukusi, Elizabeth A. M.Med, MD, MPH, PhD1,4,5; Cohen, Craig R. MD, MPH1

Journal of Lower Genital Tract Disease: July 2013 - Volume 17 - Issue 3 - p 354–360
doi: 10.1097/LGT.0b013e3182712286
Basic Science

Objective Given the high prevalence of cervical intraepithelial neoplasia (CIN) grade 2/3 among HIV-infected women, we sought to examine the relationship between CIN 2/3 and HIV-1 genital shedding among women on highly active antiretroviral therapy (HAART).

Materials and Methods Paired plasma and cervical wick specimens for HIV-1 RNA measurements were obtained from 44 HIV-infected women with biopsy-confirmed CIN 2/3 (cases) and 44 age-matched HIV-infected women with normal cervical findings on colposcopy (controls). All subjects tested negative for sexually transmitted infections and had been stable on HAART for at least 3 months. HIV-1 viral load was measured in both blood and cervical specimens using commercial real-time polymerase chain reaction assays.

Results Cervical intraepithelial neoplasia 2/3 was not significantly associated with the detection or magnitude of plasma or cervical HIV-1 RNA shedding. HIV was detected in the plasma in 10 cases (23%) and 10 controls (25%) (odds ratio = 1.0; 95% confidence interval = 0.33–3.1). Cervical HIV-1 was detected in 6 cases (13.6%) and 9 controls (20.4%) (odds ratio = 0.61; 95% confidence interval = 0.20–1.90). Mean HIV-1 concentration in cervical secretions among women with CIN 2/3 who shed was 2.93 log10 copies versus 2.72 among controls (p = .65).

Conclusions Among women on HAART, we found no relationship between CIN 2/3 and HIV-1 genital shedding.

Cervical intraepithelial neoplasia 2/3 was not associated with an increase in the detection or concentration of HIV-1 RNA in cervical secretions in women on HAART.

Departments of 1Obstetrics, Gynecology and Reproductive Services, 2Medicine, and 3Epidemiology and Biostatistics, University of California, San Francisco, San Franciso, CA; 4Department of Obstetrics and Gynecology, University of Nairobi, Naorobi, Kenya; and 5Kenya Medical Research Institute, Nairobi, Kenya

Reprint requests to: Megan Justine Huchko MD, MPH, Department of Obstetrics and Gynecology, University of California, San Francisco, 50 Beale St, Ste 1200, San Francisco, CA 94105. E-mail:

This research was supported by a grant from the National Institutes of Health, University of California, San Francisco-Gladstone Institute of Virology and Immunology Center for AIDS Research, P30-AI027763. Dr. Huchko received salary support and research funds through the NIH/NCRR/OD UCSF-CTSI Grant Number KL2 RR024130. Dr. Woo received funding for her participation in this project through the Doris Duke Charitable Foundation International Clinical Research Fellowship.

The authors have declared they have no conflicts of interest.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology