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Combination ART may not completely inhibit viral replication, block sexual transmission
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Standard combination antiretroviral therapy achieved adequate genital tract drug exposures and maintained low suppression of mucosal viral shedding. However, the detection of cervicovaginal HIV-1 RNA in some women suggests that genital drug concentrations with a standard regimen does not completely inhibit local viral replication, according to Anandi N. Sheth, MD, and colleagues.
Sheth, of Emory University School of Medicine, presented the study findings at the 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention in Rome.
The researchers investigated the prevalence and 95% CI of viral shedding and the geometric means and CI of antiretroviral drug concentrations among 20 HIV-1 infected women with suppressed plasma HIV-1 RNA. Women had received at least 6 months of combination ART with plasma viral loads of less than 50 copies/mL.
For 3 weeks after menses, blood and cervicovaginal samples were collected twice weekly, and HIV-1 RNA and antiretroviral drug concentrations in the genital tract were measured.
The researchers identified cervicovaginal lavage HIV-1 RNA in 19 samples (16%) from 45% of women; all virus-positive samples had virus loads of less than 500 copies/10 mL cervicovaginal lavage.
In addition, plasma HIV-1 RNA was identified in 69 samples (58%) from 80% of women; 56 virus-positive plasma samples had virus loads of less than 50 copies/mL.
The ratio of cervicovaginal to plasma drug concentrations (geometric mean) was as follows:
- Emtricitabine (12.2; 95% CI, 8.71-17).
- Tenofovir (3.42; 95% CI, 2.17-5.39).
- Atazanavir (2.49; 95% CI, 1.80-3.44).
For more information:
- Sheth AN. #MOAC0204. Presented at: The 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention; July 17-20, 2011; Rome.
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