Variation of Human Immunodeficiency Virus Type 1 Viral RNA Levels in the Female Genital Tract: Implications for Applying Measurements to Individual Women

Abstract

The short-term detection and variability of human immunodeficiency virus type 1 (HIV-1) RNA level was assessed in the blood plasma and genital tracts of 55 HIV-1-infected women. Specimens were collected weekly for 8 weeks from the endocervical canal with wicks and cytobrushes and from the ectocervix and vagina with cervicovaginal lavage. In all, 48 women (87.3%) had detectable genital tract HIV-1 RNA at > or =1 collection times. HIV-1 RNA levels varied least in specimens from endocervical canal wick and most in cervicovaginal lavage samples. The within-subject variation for genital-tract virus level was greater than that for blood. Overall, the odds for viral RNA detection in the genital tract approximately tripled for each 10-fold increase in plasma viral RNA concentration (P<.001) or with concomitant genital tract infection (P=.003). Endocervical canal wicks should be considered as an adjunct to cervicovaginal lavage, to improve the sensitivity and precision of HIV-1 RNA detection.

Determinants of HIV shedding in the lower genital tract of women

“…Researchers like cvl because it provides plenty of sample for analysis. It has been shown, however, to have greater variation in values than wick collections [50].…”

Roles of Clinical and Subclinical Reactivated Herpes Simplex Virus Type 2 Infection and Human Immunodeficiency Virus Type 1 (HIV‐1)–Induced Immunosuppression on Genital and Plasma HIV‐1 Levels

“…Cross-sectional studies of women in Mombasa [4] and Bangui [5] have shown positive correlations between the quantities of genital HIV-1 RNA and genital HSV-2 DNA in persons coinfected with these viruses, whereas a Zimbabwean study did not find any association [6]. The high variability of HIV-1 and HSV-2 genital shedding, both within and between individuals, has been widely reported in large studies from the United States that involved daily sampling [7][8][9], highlighting the need for a longitudinal design with multiple measurement points in order to best describe HIV-1 and HSV-2 genital shedding and identify their correlates.…”

Use of Sno Strip Filter-Paper Wicks for Collection of Genital-Tract Samples Allows Reproducible Determination of Human Immunodeficiency Virus Type 1 (HIV-1) RNA Viral Load with a Commercial HIV-1 Viral Load Assay

“…Although others have reported on biologic variation of HIV-1 RNA levels in the genital tract at separate sampling times (5,12), no previous studies have reported reproducibility of duplicate samples obtained at the same time.…”

“…In addition, other authors have reported on differences in HIV-1 RNA and DNA measurements between cervical and vaginal compartments (5,11), and it is possible that this may illustrate an actual biological difference in viral shedding between these two sites. Interestingly, many investigations of genital tract HIV-1 RNA virus have utilized the technique of cervicovaginal lavage, which does not enable discrimination between the two compartments of the genital tract (2,6,7,15).…”