Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding

James Homans, Shawna Christensen, Tracey Stiller, Chia Hao Wang, Wendy MacK, Kathryn Anastos, Howard Minkoff, Mary Young, Ruth Greenblatt, Mardge Cohen, Howard Strickler, Roksana Karim, Lashonda Yvette Spencer, Eva Operskalski, Toinette Frederick, Andrea Kovacs

Research output: Contribution to journalArticle

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Abstract

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 CVVL, 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 (-Pag < 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.

Original languageEnglish (US)
Pages (from-to)99-110
Number of pages12
JournalJournal of Acquired Immune Deficiency Syndromes
Volume60
Issue number1
DOIs
StatePublished - May 1 2012

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Viral Load
HIV
Highly Active Antiretroviral Therapy
Odds Ratio
Protective Factors
Human Herpesvirus 2
Therapeutic Irrigation
Immunologic Factors
Exudates and Transudates
Longitudinal Studies
Linear Models
Cohort Studies
Multivariate Analysis
Logistic Models
Alcohols
Inflammation

Keywords

  • Antiretroviral therapy
  • Cervicovaginal
  • HIV-1
  • Inflammation
  • Plasma viral load
  • Shedding

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding. / Homans, James; Christensen, Shawna; Stiller, Tracey; Wang, Chia Hao; MacK, Wendy; Anastos, Kathryn; Minkoff, Howard; Young, Mary; Greenblatt, Ruth; Cohen, Mardge; Strickler, Howard; Karim, Roksana; Spencer, Lashonda Yvette; Operskalski, Eva; Frederick, Toinette; Kovacs, Andrea.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 60, No. 1, 01.05.2012, p. 99-110.

Research output: Contribution to journalArticle

Homans, J, Christensen, S, Stiller, T, Wang, CH, MacK, W, Anastos, K, Minkoff, H, Young, M, Greenblatt, R, Cohen, M, Strickler, H, Karim, R, Spencer, LY, Operskalski, E, Frederick, T & Kovacs, A 2012, 'Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding', Journal of Acquired Immune Deficiency Syndromes, vol. 60, no. 1, pp. 99-110. https://doi.org/10.1097/QAI.0b013e31824aeaaa
Homans, James ; Christensen, Shawna ; Stiller, Tracey ; Wang, Chia Hao ; MacK, Wendy ; Anastos, Kathryn ; Minkoff, Howard ; Young, Mary ; Greenblatt, Ruth ; Cohen, Mardge ; Strickler, Howard ; Karim, Roksana ; Spencer, Lashonda Yvette ; Operskalski, Eva ; Frederick, Toinette ; Kovacs, Andrea. / Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding. In: Journal of Acquired Immune Deficiency Syndromes. 2012 ; Vol. 60, No. 1. pp. 99-110.
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abstract = "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 CVVL, 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 (-Pag < 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.",
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T1 - Permissive and protective factors associated with presence, level, and longitudinal pattern of cervicovaginal HIV shedding

AU - Homans, James

AU - Christensen, Shawna

AU - Stiller, Tracey

AU - Wang, Chia Hao

AU - MacK, Wendy

AU - Anastos, Kathryn

AU - Minkoff, Howard

AU - Young, Mary

AU - Greenblatt, Ruth

AU - Cohen, Mardge

AU - Strickler, Howard

AU - Karim, Roksana

AU - Spencer, Lashonda Yvette

AU - Operskalski, Eva

AU - Frederick, Toinette

AU - Kovacs, Andrea

PY - 2012/5/1

Y1 - 2012/5/1

N2 - 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 CVVL, 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 (-Pag < 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.

AB - 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 CVVL, 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 (-Pag < 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.

KW - Antiretroviral therapy

KW - Cervicovaginal

KW - HIV-1

KW - Inflammation

KW - Plasma viral load

KW - Shedding

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