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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

785-W. A Longitudinal Study of the Detection of Human Immunodeficiency Virus (HIV) Type-1 and Type-2 RNA in Vaginal Secretions among Senegalese Women S. Hawes*1, C. W. Critchlow1, M. Redman1, P. Sow2, and N. Kiviat1 1Univ. of Washington, Seattle and 2Univ. of Dakar, Senegal Background: In cross-sectional studies, we have shown that detection and levels of vaginal HIV RNA are increased among women with HIV-1 as compared to HIV-2. We undertook a longitudinal study of vaginal HIV shedding in order to evaluate whether women with HIV-1 are more likely to persistently shed HIV in the vagina. Methods: Women with HIV were recruited at the University of Dakar Infectious Disease Clinic. Blood was obtained for HIV-1 and HIV-2 RNA and DNA assays (Roche Molecular Systems, Pleasanton, CA) and a questionnaire regarding behavioral factors was administered. Vaginal lavage samples to assess HIV RNA levels were collected every 3 days for up to 6 weeks (4-12 visits), from 19 women with HIV-1 and 11 with HIV-2. Results: Among the 19 women with HIV-1, vaginal HIV RNA was never detected in 2, intermittently detected (<80% of visits) in 10, and almost always detected (>80% of visits) in 7. Among the 11 women with HIV-2, 2 women never had vaginal RNA detected, 4 were intermittent shedders, and 5 had HIV RNA frequently detected. As we found in our cross-sectional study, increased persistence of vaginal HIV shedding was associated with increased HIV plasma RNA levels, increased PBMC DNA levels, and reduced CD4 counts both among women with HIV-1 and HIV-2. Among the 14 intermittent vaginal HIV RNA shedders (124 visits from 10 women with HIV-1 and 4 with HIV-2), independent factors associated with HIV RNA detection on a specific day included HIV-1 infection (Odds Ratio, OR=3.2), recent menses (OR=3.2), amenorrhea (OR=6.5), and low CD4 count (OR=2.8 for CD4 count 200-500 cells/mL; OR=5.4 for CD4 count <200 cells/mL. Conclusions: Over a short-term (6 week) period, nearly half (47%) of HIV-1- or HIV-2-infected women intermittently had detectable quantities of HIV-1 and/or HIV-2 in the genital tract, suggesting that the absence of detectable HIV in a single sample may not reflect lack of shedding over an extended time period. Studies evaluating HIV transmission or the effect of therapy and vaginal shedding at a single visit or over widely spaced intervals must account for the potential intermittency of HIV RNA detection.

©2002 9th Conference on Retroviruses and Opportunistic Infections