Abstract 5: Cervicovaginal and Plasma HIV-1 Viral Load Among HIV-infected Women on HAART and Non-HAART Therapy
This was a cross-sectional study of 176 HIV-infected women (46% were IDUs) who had paired viral load assays (using NASBA) from the cervix (CVL) and plasma (PVL). Immunologically, 24% had a CD4 count < 200 cells/mL, 51% had a CD4 count 200-500 cells/mL, and 25% had a CD4 count > 500 cells/mL. Regarding antiretroviral therapy, 29% were on no treatment, 35% were on non-HAART antiretroviral therapy, and 36% were on HAART. The lower limit of detection for the NASBA assay was 400 copies/mL. The proportion of women whose PVL was detectable was 69% (mean = 22,000 copies/mL) and was significantly lower than found in the cervical (CVL) secretions (23%, mean = 5,000 copies/mL). Of the 122 women whose PVL was detectable, 39 (32%) also had detectable CVL. Conversely, for the 54 women whose PVL was non-detectable, 98% had a non-detectable CVL. For those with a detectable PVL, the magnitude of the PVL was strongly correlated with a detectable CVL (for those with a PVL 400-10,000 copies/mL, 8% had a detectable CVL; for those with a PVL > 10,000 copies/mL, 47% had a detectable CVL). In the multiple logistic regression analysis, having a PVL > 10,000 copies/mL (OR=30.3), and being on no antiretroviral therapy were independently correlated with predicting those with a detectable CVL; having a CD4 <200 almost achieved statistical significance. Age, race and route of transmission were not associated with a detectable CVL.
This study, similar to others, indicate that about 50% of individuals on HAART in community-derived samples have non-detectable viral loads, however the levels in the cervix may be incredibly lower with 89% of those on HAART having non-detectable CVLs. It also supports other clinical findings of a reduction in PVL is associated with a reduction in CVL. The implications for the use of HAART in reducing HIV-1 sexual transmission remain undetermined.