Comparison of sampling methods to measure HIV RNA viral load in female genital tract secretions

Problem How does menstrual cup ( MC ) compare to other genital sampling methods for HIV RNA recovery? Method of study We compared HIV RNA levels between MC , endocervical swab ( ECS ), and ECS ‐enriched cervicovaginal lavage ( eCVL ) specimens in 51 HIV ‐positive, antiretroviral therapy‐naive women at enrollment, 3 and 6 months, with order rotated by visit. Paired comparisons were analyzed with McNemar's exact tests, signed‐rank tests, and an extension of Somer's D for pooled analyses across visits. Results MC specimens had the highest proportion of quantifiable HIV VL at enrollment and month 3, but more MC specimens (n=12.8%) were insufficient for testing, compared with ECS (2%, P =0.006) and eCVL (0%, P <0.001). Among sufficient specimens, median VL was significantly higher for MC (2.62 log 10 copies/ mL ) compared to ECS (1.30 log 10 copies/ mL , P <0.001) and eCVL (1.60 log 10 copies/ mL , P <0.001) across visits. Conclusion MC may be more sensitive than eCVL and CVS , provided insufficient specimens are reduced.