Kelly Safreed-Harmon for Aidsmap (6 September 2010)
HIV-positive women whose plasma HIV RNA viral loads drop to undetectable levels following initiation of ART still may have intermittent surges in the amount of virus in their genital secretions, according to a US study.
The study analyzed changes over the course of one year in the plasma and genital tract HIV levels of US women taking ART. The journal AIDS has published the findings in an online article released in advance of print publication.
The findings have important HIV prevention implications in light of recent debates about the extent to which HIV-positive people with undetectable plasma viral load are still at risk of transmitting HIV to others.
In particular they highlight the need for evidence of viral load levels in genital secretions to be measured longitudinally in studies which monitor rates of HIV transmission in HIV-discordant sexual partnerships. Gathering these data would permit a better understanding of the clinical significance of episodic shedding of HIV in genital fluids when plasma viral load is suppressed.
The researchers suggest that the “episodic, unpredictable nature of genital tract shedding” in study participants with undetectable plasma HIV viral load levels may make it difficult to assess the HIV transmission risk in such situations.
It concludes, “Whereas genital tract shedding is primarily driven by plasma viremia, clinicians may not be able to solely rely on [ART] to eradicate the potential for the sexual and perinatal transmission of HIV.”
Genital tract HIV-1 RNA shedding among women with below detectable plasma viral load.
Cu-Uvin, Susan; DeLong, Allison K; Venkatesh, Kartik K; Hogan, Joseph W; Ingersoll, Jessica; Kurpewski, Jaclynn; De Pasquale, Maria Pia; D'Aquila, Richard; Caliendo, Angela M
AIDS: advance online publication, August 25, 2010. DOI: 10.1097/QAD.0b013e32833e5043.
Link to AIDS abstract