Infectious correlates of HIV-1 shedding in the female upper and lower genital tracts

Abstract

In HIV-1-infected, antiretroviral-naive women without symptoms of pelvic inflammatory disease infection, abnormal vaginal flora and inflammatory cells in the endometrium affected HIV-1 shedding from the lower genital tract. These data suggest that both the upper and lower genital tracts contribute to female HIV-1 genital shedding.

Mycoplasma genitalium Infection Is Associated with Microscopic Signs of Cervical Inflammation in Liquid Cytology Specimens

“…Since the prevalence of STIs would be substantially higher in high-risk populations, our findings may not be generalizable to these women since coinfections, frequent reinfection, bacterial vaginosis, and other factors may complicate the validity of measuring leukocyte/epithelial cell ratios. Importantly, cervicitis has been associated with increased HIV shedding, and treatment of the condition reduces both viral shedding and the presence of virus-infected cells in cervical secretions (51)(52)(53). Having been shown to enhance susceptibility to HIV infection (54,55), and with cross-sectional associations with HIV infection in more than 20 studies (56), continued investigation of M. genitalium remains important, as antibiotic-resistant strains continue to emerge worldwide.…”

Vaginal microbiome and sexually transmitted infections: an epidemiologic perspective

“…Over 12 months of follow-up, they found metronidazole treatment of women with high Nugent scores was associated with significantly fewer cases of incident Chlamydia trachomatis infection compared with observation alone (no antibiotic) (P = 0.02). A large randomized trial of home screening of BV to prevent acquisition of STIs is ongoing and seeks to determine whether restoring the vaginal microbiota to a stable, low pH, high lactic acid and/or lactobacillus-dominated state may help prevent acquisition of STIs upon exposure (108 (14). In a study that quantified bacteria in cervicovaginal lavage (CVL) by PCR, G. vaginalis count, M. hominis count, Nugent score, and presence of another lower genital-tract infection were associated with increased CVL HIV RNA levels (13).…”

“…Epidemiologic studies have demonstrated that BV is associated with a markedly increased risk for acquisition of sexually transmitted infections (STIs) (3)(4)(5)(6), including HIV (5,(7)(8)(9)(10), and the development of pelvic inflammatory disease (PID) (11). Transmission of STIs is also associated with BV, since BV increases viral replication and vaginal shedding of HIV-1 (7,(12)(13)(14) and herpes simplex virus type 2 (HSV-2) (15). During pregnancy, BV has been linked to late fetal loss, and 10%-30% of pregnant women with BV give birth prematurely, although there is a lack of consistent evidence that treatment of BV reduces the risk of preterm delivery (16)(17)(18)(19)(20)(21)(22)(23).…”

Impact of Mucosal Inflammation on Cervical Human Immunodeficiency Virus (HIV-1)-Specific CD8 T-Cell Responses in the Female Genital Tract during Chronic HIV Infection

“…Women are twice as likely to become infected with HIV during heterosexual sex as are men (37,38), with transmission risks for both sexes increasing with higher plasma viral loads (9). Although plasma concentrations of HIV virions are a strong predictor of transmission rates, local mucosal factors such as genital inflammation and concurrent sexually transmitted infections are also strongly associated with both increased shedding of virus at the genital tract and greater susceptibility to infection via the genital mucosa (4,6,17,30). Although immunological activation in response to invading pathogens is a crucial component of protective immunity, such responses may ironically also contribute to HIV pathogenesis by providing the virus with a steady supply of susceptible target cells (16).…”