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Session 103 Poster Session Cervico-Vaginal HIV Shedding: Immunologic and Virologic Correlates and Microbicides Session Time: 4:30-6:30 pm Room 4E-F

786-W. Detection and Characterization of CMV in Vaginal-Cervical Secretions of HIV-Infected Women N. Lurain*1, E. Robert1, M. Camarca2, A. Kovacs3, and P. Reichelderfer4 1Rush-Presbyterian-St. Luke's Med. Ctr., Chicago, IL; 2Westat, Rockville, MD; 3LAC and Univ. of Southern California Med. Ctr., Los Angeles; and 4NICHD, NIH, Rockville, MD Background: The presence of CMV in the seminal fluid has been associated with increased HIV viral loads in men. Similar data is lacking for women. This is a report of a pilot study of CMV and HIV in the genital compartment of a cohort of HIV-infected women. Methods: Genital, oral, and peripheral blood samples from 45 HIV-infected women were analyzed for CMV DNA. Paired genital supernatants and cells were analyzed for 32 subjects. DNA was extracted from each specimen: 13 PBMC, 13 plasma, 10 cervicovaginal lavage unspun, 34 lavage supernatants, 11 lavage cells, and 3 nonviable virus isolates (2 genital, 1 oral from 2 different subjects). The DNA was used as a template for PCR amplification of the UL97, DNA polymerase genes and the strain-variable UL144 gene. Nested PCR was performed when negative results occurred with first round amplification. When possible, products were directly sequenced by an ABI 3100 automated sequencer. Results: 7 of 45 subjects (16%) had detectable CMV DNA in genital secretions. For these 7 patients the HIV RNA load in the same genital samples ranged from 2200 to 53,000 copies/mL, while the plasma HIV loads ranged from 15,000 to 3,6000,000. The CD4 counts ranged from 0 to 562 cells/mm3 with a mean of 278. CMV DNA was easily detected in the 3 virus culture fluids from 2 subjects and in the unspun lavage and lavage supernatant from these same 2 subjects. PCR products containing the 3'-half of UL97, the complete DNA polymerase and UL144 genes were obtained. Sequencing of these products showed the presence of 2 unique CMV strains in each genital and oral culture specimen. In particular, 2 different sequence groups of the UL144 gene could be distinguished. Surprisingly, CMV DNA was not detected in the PBMC and plasma specimens even with nested PCR. Additionally, 5 genital lavage cell samples had detectable CMV DNA, while only one of the paired genital lavage supernatant samples was CMV DNA positive. Conclusions: CMV DNA was only detected in women with genital HIV viral loads >2000 copies/mL. CMV in the female genital tract was most readily detected in the cellular component. This is the first report of infection by more than 1 CMV strain, which in males has been linked to a greater incidence of progression to AIDS. These data suggest a need for further exploration of the potential interaction between CMV and HIV in the female genital tract.

©2002 9th Conference on Retroviruses and Opportunistic Infections