Cervicovaginal (CV) HIV DNA, RNA, and Markers of Inflammation in HIV+ Women Before and After Treatment for Vaginitis

K.H. MAYER*, S. CU-UVIN, L. TUCKER, C. XU, I. RODRIGUEZ, T. FLANIGAN D.J. ANDERSON Brown University AIDS Program, Providence, RI and Harvard Medical School, Boston, MA

In order to assess the effect of treating vaginitis on genital tract infection and inflammation, 22 HIV+ women participants in a prospective cohort study (HERS) who developed vaginitis between 12/96 and 2/98 underwent CV lavage and microbiologic dx before and after rx. 11 had vaginal candidiasis; 4 had bacterial vaginosis (BV); 4 had trichomoniasis (T) plus BV; 1 had T alone, and 1 had HSV. The women's median blood CD4 count was 464 cells/mm³ (range 131-1388) and median plasma HIV RNA (by PCR) was 2,400 copies/ml (range <40 to 87,200). The median levels of HIV cell-free CV RNA, and cell-associated CV RNA and DNA PCR were undetectable, but the maximal level for CF CV RNA was 18,750 pre-rx and 800 post-rx; compared to 1,067 copies/ml in CD4-matched HIV+ controls who did not have vaginitis. The range of CV WBC counts was similar pre and post-rx, from 0 to more than 5x10⁶ WBC/ml, but the median counts were 13,000 pre-rx to 8,000 post-rx. CV IL-1 beta levels ranged from 0 to more than 2,000 pcg/ml in both pre and post-rx samples, but the median level went from 80 pre-rx to 0 after rx, and was detected in 15 women pre-rx, but only 10 post-rx. Median RANTES levels were 9.3 pcg/ml in women pre-rx, but 0 post-rx. TNF-alpha was detected only once in different women pre-rx and post-rx.

Conclusion: Vaginitis rx may decrease CV HIV RNA, but effects of rx. on genital WBC and cytokines are highly variable, reflecting the complex micro-environment.

Key Words: Cervicovaginal, Genital Tract, Vaginitis