Cervical Inflammation Dramatically Increases HIV-1 Shedding - avoid sexual intercourse for 4 weeks after treatment of cervical lesions
WESTPORT, CT (Reuters Health) - Cervical inflammation and ulceration have a major influence on HIV-1 shedding in the female genital tract, study findings indicate. "Determining the source of HIV-1 in the female genital tract and identifying factors that influence the amount of virus shed are important in the understanding of heterosexual HIV-1 transmission," researchers write in the February issue of the American Journal of Obstetrics and Gynecology. Dr. Thomas C. Wright, Jr. of Columbia University in New York and colleagues there and elsewhere determined the levels of HIV-1 RNA in cervicovaginal secretions in 14 HIV-1-infected women before and after treatment of cervical squamous intraepithelial lesions. The results of previous research suggest that, in the absence of genital tract inflammation, the amount of HIV-1 RNA in cervicovaginal secretions parallels the amount found in plasma. However, Dr. Wright and colleagues found that cervicovaginal inflammation exponentially increases HIV-1 expression in cervical secretions. That is, 2 to 4 weeks after treatment, when cervices were inflamed and ulcerated, the amount of HIV-1 shed into genital secretions was increased between 10- and 10,000-fold. Six to 14 weeks following treatment, when the cervix was largely healed, HIV-1 expression returned to pretreatment levels in the majority of women. Different genotypes in plasma and cervical secretions observed in two women point to local production of HIV-1.These findings, the authors write, "may explain why sexually transmitted diseases such as syphilis, chancroid, and genital herpes are such important risk factors for HIV transmission." They recommend advising HIV-infected women against having sexual intercourse for at least 4 weeks after treatment of cervical lesions to reduce the risk of HIV-1 transmission.
Am J Obstet Gynecol 2001; 184:279-285.