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The Center for AIDS, Houston, TX

Session 88: HIV-1 Replication in the Female Genital Tract. On Wednesday, one poster series examined HIV replication in the female genital tract. Most of these studies analyzed samples taken from cervical lavage fluid to determine if HIV genotype in the genital tract is similar to that found in blood. Abstract 710 concluded that this was indeed the case, indicating the significance of this for understanding transmission of HIV. Abstract 711 found that HIV can be readily detected in the female genital tract of up to 70% of women, using a variety of collection techniques such as blood, swab and lavage samples. Further, HIV RNA appears to be more readily detectable in the genital tract of women who have detectable plasma viral loads. Abstract 713 found that antiretroviral therapy reduces HIV RNA levels in the genital tract. These findings indicate that viral replication is ongoing locally and should be considered when evaluating new treatment modalities.

Session 89, Poster 722: A Study in HIV Positive Women of Quadruple Therapy: Nelfinavir, Saquinavir, Stavudine, and Lamivudine. Agouron has been conducting a study to increase investigators' experience with nelfinavir in women. An ongoing study is evaluating the pharmakokinetics, virologic efficacy and effect of therapy on HIV RNA in the genital tract. Twenty-seven women are currently enrolled in two treatment arms using NFV either b.i.d. or t.i.d, in combination with saquinavir (SQV) hard gel cap, d4T and 3TC. In this population, in which half were previously treated, antiviral activity was observed by the second week and durability of the response continues to be maintained out to week 16. Mean reduction in viral load was 2.2 log in the b.i.d. arm, with 85.7% of patients undetectable and 2.0 in the t.i.d. arm, with 75% undetectable. Women on the thrice-daily regimen had a slightly better improvement in CD4+ cell count (145 cells/mm³ compared to 119 cells/mm³ on the b.i.d. regimen).