Antiretroviral Adherence and Development of Drug Resistance Are the Strongest Predictors of Genital HIV-1 Shedding among Women Initiating Treatment

April 23, 2011 at 3:44 pm Leave a comment

Journal of Infectious Diseases 15 Nov  2010  V.202  N.10 P.1538-1542

Susan M. Graham1,3,5,7, Linnet Masese1,3, Ruth Gitau3, Zahra Jalalian-Lechak2, Barbra A. Richardson1, Norbert Peshu5, Kishor Mandaliya6, James N. Kiarie4, Walter Jaoko3, Jeckoniah Ndinya-Achola3, Julie Overbaugh2 and R. Scott McClelland1,3

1University of Washington, Seattle, Washington

2Fred Hutchinson Cancer Research Center, Seattle, Washington

3University of Nairobi, Nairobi, Kenya

4Kenyatta National Hospital, Nairobi, Kenya

5Kenya Medical Research Institute, Kilifi, Kenya

6Coast Provincial General Hospital, Mombasa, Kenya

7University of Toronto, Toronto, Ontario, Canada


Persistent genital human immunodeficiency virus type 1 (HIV-1) shedding among women receiving antiretroviral therapy (ART) may present a transmission risk. We investigated the associations between genital HIV-1 suppression after ART initiation and adherence, resistance, pretreatment CD4 cell count, and hormonal contraceptive use. First-line ART was initiated in 102 women. Plasma and genital HIV-1 RNA levels were measured at months 0, 3, and 6. Adherence was a strong and consistent predictor of genital HIV-1 suppression (P < .001), whereas genotypic resistance was associated with higher vaginal HIV-1 RNA level at month 6 (P = .04). These results emphasize the importance of adherence to optimize the potential benefits of ART for reducing HIV-1 transmission risk.


Entry filed under: Antirretrovirales, HIV/SIDA, HIV/SIDA HAART, HIV/SIDA Infecciones Oportunistas, HIV/SIDA Mujeres.

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