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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Initiation of antiretroviral therapy leads to a rapid decline in cervical and vaginal HIV-1 shedding
AIDS, Volume 21, No. 4, Year 2007
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Description
BACKGROUND: Antiretroviral therapy (ART) may decrease HIV-1 infectivity in women by reducing genital HIV-1 shedding. OBJECTIVES: To evaluate the time course and magnitude of decay in cervical and vaginal HIV-1 shedding as women initiate ART. METHODS: This prospective, observational study of 20 antiretroviral-naive women initiating ART with stavudine, lamivudine, and nevirapine measured HIV-1 RNA in plasma, cervical secretions, and vaginal secretions. Qualitative polymerase chain reaction estimated HIV-1 DNA in cervical and vaginal samples. Perelson's two-phase viral decay model and non-linear random effects were used to compare RNA decay rates. Decreases in proviral DNA were evaluated using logistic regression and generalized estimating equations. RESULTS: Significant decreases in the quantity of HIV-1 RNA were observed by day 2 in plasma (P < 0.001), day 2 in cervical secretions (P = 0.001), and day 4 in vaginal secretions (P < 0.001). Modeled initial and subsequent RNA decay rates in plasma, cervical secretions, and vaginal secretions were 0.6, 0.8, and 1.2 log10 virions/day, and 0.04, 0.05, and 0.06 log10 virions/day, respectively. The initial decay rate for vaginal HIV-1 RNA was more rapid than for plasma RNA (P = 0.02). Detection of HIV-1 DNA decreased significantly in vaginal secretions during the first week (P < 0.001). At day 28, 10 women had detectable HIV-1 RNA or proviral DNA in genital secretions. CONCLUSIONS: Genital HIV-1 shedding decreased rapidly after ART initiation, consistent with a rapid decrease in infectivity. However, incomplete viral suppression in half of these women may indicate an ongoing risk of transmission. © 2007 Lippincott Williams & Wilkins, Inc.
Authors & Co-Authors
Graham, Susan Marie
United States, Seattle
University of Washington
Kenya, Nairobi
University of Nairobi
Holte, Sarah E.
United States, Seattle
University of Washington
United States, Seattle
Fred Hutchinson Cancer Research Center
Peshu, Norbert M.
Kenya, Nairobi
Kenya Medical Research Institute
Richardson, Barbra Ann
United States, Seattle
University of Washington
Panteleeff, Dana De Vange
United States, Seattle
Fred Hutchinson Cancer Research Center
Jaoko, Walter G.
Kenya, Nairobi
University of Nairobi
Ndinya-Achola, Jeckoniah O.
Kenya, Nairobi
University of Nairobi
Mandaliya, Kishor N.
Kenya, Mombasa
Coast Provincial General Hospital, Kenya
Overbaugh, Julie M.
United States, Seattle
Fred Hutchinson Cancer Research Center
McClelland, Raymond Scott
United States, Seattle
University of Washington
Kenya, Nairobi
University of Nairobi
Statistics
Citations: 139
Authors: 10
Affiliations: 5
Identifiers
Doi:
10.1097/QAD.0b013e32801424bd
Research Areas
Genetics And Genomics
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Study Approach
Qualitative
Participants Gender
Female