9th Conference on Retroviruses and Opportunistic Infections Seattle, Washington - February 24 -February 28, 2002

Conf Retroviruses Opportunistic Infect 2002 Feb 24-28;9:abstract no. 19
C. W. Critchlow¹ , S. Hawes¹, M. Redman¹, P. Sow², and N. Kiviat^1
1Univ. of Washington, Seattle and ²Univ. of Dakar, Senegal, West Africa

BACKGROUND: Infectivity of persons with HIV is likely related to quantity of HIV in genital secretions. We sought to determine if lower rates of transmission of HIV-1 vs HIV-2 might be explained by differences in frequency or levels of HIV in the genital tract, at a given stage of HIV disease, of women with HIV-1 vs HIV-2.

METHODS: Women with HIV were recruited from among patients at the University of Dakar Infectious Disease Clinic. Blood was obtained for HIV-1 and HIV-2 RNA and DNA assays (Roche Molecular Systems, Pleasanton, CA), vaginal lavage samples were taken to assess levels of HIV RNA, and a questionnaire regarding behavioral factors was administered.

RESULTS: Women with HIV-1 (n=170) vs HIV-2 (n=51) were more likely to be younger (31 vs 36 years), unmarried, and present with lower CD4 (301 vs 352 cells/mL) and higher CD8 count (975 vs 676 cells/mL) and more advanced HIV disease. Among women with HIV-1, 82% of vaginal samples were positive for HIV-1 RNA and 50% were positive for HIV-1 DNA. In women with HIV-2, 59% were positive for HIV-2 RNA and 23% were positive for HIV-2 DNA. Vaginal HIV RNA was often found in the absence of HIV DNA, with HIV-1 RNA detected in 73% of HIV-1 DNA negative samples compared to detection of HIV-2 RNA in 53% of HIV-2 DNA negative samples. Further, among women with vaginal HIV detected, > 1000 HIV RNA copies/mL were more often detected in women with HIV-1 (46%) than HIV-2 (0%). Factors associated with detection of vaginal HIV RNA both among women with HIV-1 and HIV2 included age > 40 years, parity, being divorced or widowed, later WHO disease stage, vaginal pH > 5.2, genital infection (HPV, vaginal candidiasis, bacterial vaginosis), increased HIV plasma RNA levels and lower CD4 count, although the magnitude of associations were somewhat less among women with HIV-2. Factors associated with higher vaginal HIV RNA levels were HIV type (HIV-1 vs HIV-2), lower CD4 count, higher plasma HIV RNA levels and vaginal pH. HIV-1 was significantly associated with vaginal HIV RNA level even after adjusting for CD4 count and vaginal pH, although this difference was attenuated after adjusting for plasma HIV level.

CONCLUSIONS: Frequency of detection and vaginal HIV RNA levels were higher among women with HIV-1 than HIV-2. Increased rates of vaginal HIV shedding, and most likely, of transmission, seen among women with HIV-1 appears to be attributable to higher viral burden at a given CD4 count among women with HIV-1.

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