AEGiS-13IAC: Treatment of cervicitis is associated with decreased cervical shedding of HIV-1 DNA.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Treatment of cervicitis is associated with decreased cervical shedding of HIV-1 DNA.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrA231)

McClelland R, Wang C, Mandaliya K, Overbaugh J, Reiner M, Ndinya-Achola J, Bwayo J, Kreiss J, Panteleef D, Lavreys L
R. McClelland, University of Washington, Box 359909, 325 9th Ave., Seattle, WA 98104, United States, Tel.: +1 206 731 28 22, Fax: +1 206 731 24 27, E-mail: mcclella@africaonline.co.ke

BACKGROUND: Sexually transmitted diseases (STDs) are associated with increased shedding of HIV-1 RNA and proviral DNA in genital tract secretions. The objective of this study was to determine whether shedding of HIV-1 DNA in cervical secretions decreases after successful treatment of cervicitis.

METHODS: A prospective interventional study was conducted among 36 HIV-1 seropositive women treated for N. gonorrhoeae, C. trachomatis, or nonspecific cervicitis at a large public hospital in Mombasa, Kenya. Cervical secretions for diagnosis of STDs and detection of HIV-1 DNA were collected before and after STD treatment. The main outcome measure was the presence of HIV-1 DNA in cervical secretions before and after resolution of cervicitis.

RESULTS: Among the 36 patients, 16 (44.4%) had N. gonorrhoeae, 7 (19.4%) C. trachomatis, and 13 (36.1%) nonspecific cervicitis. HIV-1 DNA was detected in the cervical secretions of 24 (66.7%) patients before treatment, compared with 15 (41.7%) following resolution of cervicitis (OR = 2.8, CI = 1.3-6.0, p = 0.009). The decrease in shedding was accompanied by a reduction in the median polymorphonuclear leukocyte count of gram stained cervical secretions from 23.2 to 4.0 per high power field (p>0.001).

CONCLUSIONS: Effective treatment of cervicitis resulted in a 2.8-fold reduction in shedding of HIV-1 DNA in cervical secretions. The analysis of patients before and after treatment provides evidence of a causal association between cervicitis and shedding of the virus, suggesting a biologically plausible link between treatment of STDs and decreased infectivity. Our findings suggest that STD treatment programs should be part of a comprehensive strategy to reduce HIV-1 transmission.

Keywords: AEGIS, Cervicitis, HIV-1, Sexually Transmitted Diseases, Gonorrhea, Prospective Studies, Kenya, Human, Female, therapy
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MoOrA231