Genital tract HIV-1 RNA shedding among women with below detectable plasma viral load

Abstract

Women with below-detectable PVL may have less risk of HIV sexual transmission on a population level, but may continue to be infectious on an individual level.

Evaluation of Performance Characteristics of the Aptima HIV-1 Quant Dx Assay for Detection and Quantitation of Human Immunodeficiency Virus Type 1 in Plasma and Cervicovaginal Lavage Samples

“…A number of studies have attempted to compare HIV loads in plasma and genital secretions, especially CVL specimens, for patients on ART, many with conflicting results (6)(7)(8)25). Hence, an assay that can quantify HIV-1 RNA without compromising the detection accuracy in both plasma and CVL specimens is important in HIV diagnostics as well as from a research perspective.…”

“…RNA levels in cervicovaginal lavage (CVL) specimens are usually lower than plasma HIV-1 RNA loads; thus, HIV-1 RNA suppression in the genital tract may occur more rapidly than in plasma after initiation of therapy (6). Nevertheless, more recent studies demonstrate that genital HIV-1 RNA shedding occurs in women on highly active antiretroviral therapy (HAART) even in the absence of plasma viremia (7,8). Therefore, an HIV-1 assay that accurately quantifies both genital and plasma RNA levels is a powerful research tool to better understand HIV-1 pathogenesis in the genital tract.…”

Significance and Clinical Management of Persistent Low-Level Viremia and Very-Low-Level Viremia in HIV-1-Infected Patients

“…However, a recent study reported the presence of HIV RNA in seminal fluid (135 to 2,365 cpm) in 6.6% of patients at time points when plasma HIV-1 RNA was not detectable (101). Others have also recovered both free and cell-associated HIV RNA from genital secretions of individuals with undetectable HIV in plasma (102), possibly reflecting the limited penetration of antiretroviral drugs into the genital compartment (102)(103)(104).…”

Complex Decisions in Managing HIV Infection During Pregnancy

“…This may be due to differences in serum viral loads and the amount viral shedding that occurs in the genital tract of HIV-infected women. Cu-Uvin [52] has recently shown that more than half of women who had an undetectable serum HIV-1 RNA viral load while receiving combination antiretroviral therapy had intermittent or persistent viral shedding of HIV in the genital tract. Therefore, invasive monitoring with scalp electrodes or fetal scalp pH blood sampling should continue to be avoided, even in patients with undetectable serum viral loads.…”