Women's Treatment Issues
October 1, 2001
Through the AIDS pandemic, a major focus of basic and clinical research has been on the role of small proteins called cytokines in the body's response to infection by HIV. Indeed, some cytokines, most notably interleukin-2, are under investigation as therapeutic agents in the treatment of HIV disease. More recently, a discussion of cytokines has been taking place in regard to women living with HIV. Women with HIV have noted many complaints about abnormal menses (periods). In the past few years, studies have examined menstrual abnormalities in HIV infected women. A recent article in the August 17 issue of AIDS presents a broad picture of the biological actions of cytokines in relation to menses.
The article reports the results of a study of 55 HIV-positive women. The study noted a general increase in the number of vaginal cytokines near the time of menses. The researchers measured cytokine levels in plasma and vaginal samples and cytokines appeared to be elevated during menses in comparison with the follicular and luteal phase of the menstrual cycle. This cytokine fluctuation seemed to correlate with vaginal viral load and could account for an increased risk of female-to-male HIV transmission at this phase of the menstrual cycle. The comparison of viral load levels in vaginal secretions to levels in the blood, to determine whether the vaginal area remains an HIV reservoir, is still being debated because more studies are needed to confirm these facts.
Interleukins (IL)-1-beta, IL-4, IL-6, IL-8 and IL-10, transforming growth factor-beta (TGF-beta), macrophage-inflammatory protein 1 (MIP-1)-beta, RANTES and TNFR-II are the cytokines that appeared to be elevated. The cytokine increases seemed to coincide with an increase in HIV in the female genital tract but not at other sites (plasma and saliva). The researchers advised these patients of the potential additional risk of HIV transmission to their partners during menses and immediately prior to menses and advised them to either abstain from intercourse during those times or take extra precautions in light of the findings.
In response to the limited availability of clinical data on women, the fastest growing population infected with HIV, it is clear that more research needs to focus on how HIV in the female reproductive tract varies with stage of disease and how women at varying stages of HIV are affected by disease changes. This study shows interest in the impact of female physiology on the pathogenesis of HIV, which tends to be understudied. Therefore, it is possible that research on genital viral load in women may continue to be a priority.
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Ezine.