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

@article{Graham2007InitiationOA,
  title={Initiation of antiretroviral therapy leads to a rapid decline in cervical and vaginal HIV-1 shedding},
  author={Susan M. Graham and Sarah E Holte and Norbert Peshu and Barbra A. Richardson and Dana DeVange Panteleeff and Walter Jaoko and Jeckoniah O. Ndinya-Achola and Kishorchandra N. Mandaliya and Julie M. Overbaugh and R. Scott McClelland},
  journal={AIDS},
  year={2007},
  volume={21},
  pages={501–507}
}
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… 
Effect of acquisition and treatment of cervical infections on HIV-1 shedding in women on antiretroviral therapy
TLDR
Although these data show a statistically significant increase in cervical HIV-1 RNA detection when cervical infections are present, most cervical HIV/1 RNA concentrations were near the threshold for detection, suggesting that infectivity remains low.
HIV-1 RNA May Decline More Slowly in Semen than in Blood following Initiation of Efavirenz-Based Antiretroviral Therapy
TLDR
The observations suggest that there is suboptimal suppression of seminal HIV-1 RNA for some men in the early weeks of treatment with efavirenz-based ART, and this difference was of borderline significance in this small study.
A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy
TLDR
Detection of vaginal HIV-1 RNA during ART was uncommon at visits before, during and after T. vaginalis infection, and detection of HIV- 1 RNA was similar before infection versus after successful treatment.
Longitudinal effect following initiation of highly active antiretroviral therapy on plasma and cervico-vaginal HIV-1 RNA among women in Burkina Faso
TLDR
The findings suggest that HAART could play a role in reducing HIV transmission in Africa; however, they underscore the need to emphasise safe sex practices with patients taking HAART.
Cervicovaginal HIV-1 Shedding in Women Taking Antiretroviral Therapy in Burkina Faso: A Longitudinal Study
TLDR
Certain ART regimens, abnormal vaginal discharge, bacterial vaginosis, and genital herpes simplex virus-2 are associated with HIV-1 cervicovaginal shedding or quantity in women on ART after adjusting for PVL, which may reduce the effectiveness of ART as prevention in high-risk populations.
HIV-DNA in the Genital Tract of Women on Long-Term Effective Therapy Is Associated to Residual Viremia and Previous AIDS-Defining Illnesses
TLDR
HIV-RNA was undetectable in the genital tract of women with sustained control of PVL on cART, and HIV-DNA shedding persisted in about one third of cases, with no substantial evidence of residual infectiousness.
Prevalence, Magnitude, and Correlates of HIV-1 Genital Shedding in Women on Antiretroviral Therapy
TLDR
Prevalence of shedding did not vary by time since ART initiation when plasma VL was detectable, though the magnitude of shedding significantly increased, and reducing immune activation through prevention and treatment of HIV-related conditions and genital tract infections may decrease the risk of HIV -1 shedding and potential transmission.
Impact of suppressive herpes therapy on genital HIV-1 RNA among women taking antiretroviral therapy: a randomized controlled trial
TLDR
HSV-2 facilitates residual herpes simplex virus 2 replication among dually infected women taking HAART despite HIV-1 suppression at the systemic level and reduces both the proportion of visits with detectable HIV- 1 shedding and the quantity of genital HIV-2 RNA during these visits.
Genital shedding of human immunodeficiency virus type-1 (HIV) when antiretroviral therapy (ART) suppresses HIV replication in the plasma.
TLDR
The findings infer that HIV RNA is shed due to proliferation of infected cells with virion production, rather than HIV replication as the cause of DS from the genital tract.
Antiretroviral adherence and development of drug resistance are the strongest predictors of genital HIV-1 shedding among women initiating treatment.
TLDR
The associations between genital HIV-1 suppression after ART initiation and adherence, resistance, pretreatment CD4 cell count, and hormonal contraceptive use are investigated to emphasize the importance of adherence to optimize the potential benefits of ART for reducing HIV- 1 transmission risk.
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