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Factors associated with nucleic acids related to human immunodeficiency virus type 1 in cervico‐vaginal secretions
Author(s) -
Spinillo Arsenio,
Debiaggi Maurizia,
Zara Francesca,
Maserati Renato,
Polatti Franco,
Santolo Antonella
Publication year - 2001
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2001.00141.x
Subject(s) - bacterial vaginosis , nucleic acid , rna , trichomonas vaginalis , reverse transcriptase , trichomonas , polymerase chain reaction , biology , virology , virus , medicine , gene , microbiology and biotechnology , biochemistry
Objective To assess HIV‐related nucleic acids in cervico‐vaginal secretions and the factors associated with them. Design Observational study. Setting Department of Obstetrics and Gynaecology, University of Pavia, Italy. Population HIV‐positive patients attending a cytology service. Methods Paired blood and cervico‐vaginal lavage samples were obtained from 122 known HIV‐seropositive patients during periodic visits for cytologic screening for lower genital tract neoplasia. Vaginal specimens for the diagnosis of bacterial vaginosis, trichomonas vaginalis and candida infection were also obtained. HIV‐1‐RNA in plasma, proviral HIV‐1‐DNA, cell associated and cell‐free HIV‐1 RNA in cervico‐vaginal secretions were quantitatively evaluated by competitive polymerase chain reaction (c‐PCR) and reverse transcriptase PCR (cRT‐PCR). Main outcome measure Prevalences of HIV related nucleic acids in cervico‐vaginal secretions and their univariate and multivariate associations with clinical variables. Results Proviral HIV‐1 DNA, cell‐associated and cell‐free HIV‐1 RNA were detected in 50% (61/122), 37.7% (46/122) and 32.8% (40/122) of the patients, respectively. In logistic regression analysis, the presence of HIV‐1 RNA in blood was the factor which correlated best with the detection of HIV‐1 DNA ( OR = 5.48, 95% CI=2.28‐13.20 ), cell‐associated ( OR = 4.85; 95% CI = 1.89–12.45 ) and cell‐free HIV‐1 RNA ( OR = 4.63, 95% CI = 1.74–12.33 ) in cervico‐vaginal samples. However, between 20% and to 35% of patients who tested negative for blood HIV‐1 RNA were positive for either HIV‐1 DNA or HIV‐1 RNA detection in cervico‐vaginal lavages. Bacterial vaginosis was associated with an increased prevalence of cell‐associated ( OR=3.58, 95% CI = 1.22–10.54 ) and cell‐free HIV‐1 RNA ( OR = 2.94, 95% CI = 1.0–8.7 ) detection in cervico‐vaginal secretions. Additional factors associated with increased prevalence of HIV‐1 RNA detection were advanced stage of HIV disease and vulvovaginal candidiasis. Conclusions Although the presence of HIV‐1 RNA in blood is the factor which correlates best with the detection of HIV‐related nucleic acids in cervico‐vaginal secretions, the shedding of HIV in the genital tract can occur in 20‐30% of non‐viremic subjects. Bacterial vaginosis and candida infection could have a facilitating role in local HIV viral replication and shedding.