Initiation of antiretroviral therapy leads to a rapid decline in cervical and vaginal HIV-1 shedding

Abstract

Background Antiretroviral therapy (ART) may decrease HIV-1 infectivity in women by reducing genital HIV-1 shedding. Objectives To evaluate the time course and magnitude of decay in cervical and vaginal HIV-1 shedding as women initiate ART. Methods This prospective, observational study of 20 antiretroviral-naive women initiating ART with stavudine, lamivudine, and nevirapine measured HIV-1 RNA in plasma, cervical secretions, and vaginal secretions. Qualitative polymerase chain reaction estimated HIV-1 DNA in cervical and vaginal samples. Perelson's two-phase viral decay model and non-linear random effects were used to compare RNA decay rates. Decreases in proviral DNA were evaluated using logistic regression and generalized estimating equations. Results Significant decreases in the quantity of HIV-1 RNA were observed by day 2 in plasma (P Conclusions Genital HIV-1 shedding decreased rapidly after ART initiation, consistent with a rapid decrease in infectivity. However, incomplete viral suppression in half of these women may indicate an ongoing risk of transmission.