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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

784-W. Factors Associated with HIV-1 RNA Shedding in the Female Genital Tract: 24-Month Follow-Up S. Cu-Uvin*1, A. Caliendo2, B. Snyder1, J. Hogan1, K. Mayer1 , S. Donahue1, J. Allega2, J. Kurpewski1, J. Harwell1, T. Flanigan1, and C. C. J. Carpenter1 1Brown Univ., Providence, RI and 2Emory Univ., Atlanta, GA Background: Most studies assessing factors associated with HIV-1 shedding in the female genital tract have been cross-sectional. We determined the association between cervicovaginal lavage (CVL) HIV-1 RNA and antiretroviral therapy, PVL, CD4 count, lower genital tract infections (LGTI), and the presence of semen among HIV-infected women followed over a 24-month period. Methods: 97 HIV-infected women were enrolled in a longitudinal study to assess the effect of antiretroviral therapy on HIV-1 in the genital tract. PVL, CVL viral load, tests for presence of LGTI and semen were done at baseline, 2 weeks, 1 month, and every 6 months thereafter. HIV-1 RNA was quantitated by NASBA (lower limit of detection at 400 copies/mL). Women were divided into 3 groups: group A, antiretroviral naïve starting highly active antiretroviral therapy (HAART) n=36; group B, nucleoside experienced starting on HAART, n=26; and group C, no past or present therapy, n=35. Results: 52% had history of injection drug use. 68% have had sex with an HIV+ partner. 6% of the samples were positive for trichomonas, 35% for bacterial vaginosis, 18% for candida, and 6% for the presence of semen. % CVL HIV-1RNA <400 copies/mL by Group Over All Visits Group Baseline 2 wks 1 mo 6 mos 12 mos 18 mos 24 mos A           67        83      86      92       88        88        83 B           71        78      82      73       93        90        91 C           79        92      81      79       75        84       61 On logistic regression analysis, there was a highly significant association between PVL and detection of CVL HIV-1 RNA. For each log10 increase in PVL, there was a 4-fold increase in the odds of CVL viral load detection (OR 3.7, p=< 0.0001).The presence of semen in the genital tract was significantly associated with detectable CVL viral load (OR 2.3, p=0.39). There was no significant difference in CVL HIV-1 RNA detection by antiretroviral grouping and by CD4 cell count. The odds of having detectable CVL viral load was lower among women without LGTI but this did not reach statistical significance (OR .80, p=0.53). Conclusions: Plasma viral load is most associated with the presence of HIV-1 RNA in the genital tract. Many HIV+ women have HIV+ partners. The presence of semen should be assessed in genital tract samples because this was significantly associated with HIV-1 in the female genital tract. The source of HIV-1 may be from the semen of an HIV+ partner.

©2002 9th Conference on Retroviruses and Opportunistic Infections