AEGiS-13IAC: Impact of sexually transmitted deseases (STDs) on plasma HIV-1 viral load (VL) and immune activation markers among HIV-1 seropositive female sex workers (FSWs) in Abidjan, Cote d'Ivoire.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Impact of sexually transmitted deseases (STDs) on plasma HIV-1 viral load (VL) and immune activation markers among HIV-1 seropositive female sex workers (FSWs) in Abidjan, Cote d'Ivoire.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrB613)

Nkengasong JN, Kestens L, Ghys P, Koblavi-Deme S, Diallo MO, Bile C, Kalou M, Maurice C, Laga M, Wiktor SZ, Greenberg AE
J.N. Nkengasong, Projet Retro - CI, 01 BP 1712, Abidjan 01, Cote D'ivoire, Tel.: +225 212 541 11, Fax: +225 212 429 69, E-mail: jcn5@cdc.gov

OBJECTIVE: To assess the impact of STDs on HIV-1 RNA viral load and markers of immune activation among FSW in Abidjan, Cote d'Ivoire.

METHODS: We analyzed blood and cervicovaginal samples obtained from consenting HIV-seropositive FSWs attending a confidential clinic between September 1996 and June 1997. Syphilis was diagnosed by TPHA and RPR testing, N. gonorrhoeae by culture, T. vaginalis by wet mount, and C. trachomatis by enzyme immunoassay, and genital ulcers were diagnosed clinically. VL (log₁₀ copies/mL) was quantified by the Amplicor HIV-1 Monitor test (Roche Diagnostic). Markers of immune activation (MIA) were assessed by three-color FACScan flow cytometry, and levels of soluble tumor necrosis factor receptor (sTNF_RII) and b 2-microglobulin by ELISA.

RESULTS: Of 198 HIV positive FSWs, 87 (44%) were diagnosed with at least one STD. Median age (26 years) and duration of commercial sex (24 months) was similar for FSWs with and without an STD. Median (interquartile range [IQR]) CD4+ T-cell count was 488 (357-766) for women with STDs compared with 640 (359-1005) (p = 0.14) in women without an STD. Median VL was higher in the STD (4.8 [3.7-5.3]) than non-STD group (4.4 [3.7-5.3]) (p = 0.009). This difference remained statistically significant after adjusting for CD4-count (difference in VL between groups = 0.4, p = 0.053). Median VL was higher for women with a genital ulcer (n = 11; 5.4 [4.3-6.4]; p = 0.058) and gonorrhoea (n = 45; 4.9 [4.4-5.3]; p = 0.058) than for women without any STD. Infection with the other STDs also showed a trend towards increased VL, albeit non-significant. Median levels of MIA (CD38 and HLA-DR on CD8+ T-cells, sTNF_R-II and b 2 miroglobulin) were higher, but not significantly, among FSWs with STDs compared with those without STDs.

CONCLUSION: Our results indicate that among FSW, the presence of an STD is associated with higher plasma viral load. Prospective studies are needed to assess whether this higher viral load accelerates the clinical course of HIV infection or increases the transmissibility of HIV.

Keywords: AEGIS, Viral Load, HIV-1, HIV Infections, CD4 Lymphocyte Count, HIV Seropositivity, Biological Markers, HIV Seronegativity, HIV, Receptors, HIV, Gonorrhea, Syphilis, Prospective Studies, Cote d'Ivoire, Human, Female, immunology
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WeOrB613