Multiple factors affect the rate of...

Multiple factors affect the rate of genital human immunodeficiency virus (HIV) shedding, which subsequently affects vertical transmission and sexual acquisition of HIV. Local genital factors (eg genital sore disease, bacterial vaginosis, Trichomonas vaginalis) have been shown to increase the risk for sexual transmission of HIV. In single study, women with vulvovaginal candidiasis had increased carriage of proviral HIV-1 DNA. In another cogitation women with vaginal Candida colonization or infection had a higher prevalence of cell-free HIV-1 RNA in cervicovaginal secretions compared with superintend patients who had negative agricultures Although a link between vaginal infections and HIV transmission has not been established, the factors that influence HIV shedding and replicative life period may be important in prevention programs. Spinillo and colleagues evaluated by what means symptomatic vulvovaginal candidiasis affects HIV-1 shedding in cervicovaginal secretions in women with HIV-1 infection.

The prospective, observational, case-control studious mood included women with known HIV-1 infections and symptomatic vulvovaginal candidiasis. The curb group included patients who were seropositive for HIV and negative for vulvovaginal infections. Paired life-current and cervicovaginal lavage samples were mustered from women in both collections The blood samples were used to assess the CD4+ lymphocyte enclosed space count and quantifying HIV-1 RNA in plasma. The cervicovaginal samples were used in the quantitative evaluation of proviral HIV-1 DNA, HIV-1 RNA transcripts, and cell-free HIV-1 RNA. Logistic regression analysis was used to evaluate the influence of vulvovaginal candidiasis forward the HIV-1 load in cervicovaginal secretions.

Final analysis included 66 patients who were seropositive for HIV with vulvovaginal candidiasis and 249 in the mastery group. The amount of HIV-1 RNA in plasma was significantly correlated with the cervicovaginal secretion load of HIV-1 DNA, HIV-1 RNA transcripts, and cell-free HIV-1 RNA. Approximately 26 percent of patients who exampleed negative for HIV-1 RNA in the plasma had HIV-DNA in their cervicovaginal secretions. The appearance of vulvovaginal candidiasis was significantly associated with increased loads of cell-free HIV-1 RNA and HIV-1 transcripts.

The authors judge that the presence of vulvovaginal candidiasis is associated with an increase in the number of copies of cell-associated and cell-free HIV-1 RNA in women who are seropositive for HIV. They add that treatment and adequate prophylaxis of vulvovaginal candidiasis in women with HIV is important in reducing the risk for HIV transmission.

KARL E MILLER, MD Spinillo A, et al. The meaning of vaginal candidiasis on the shedding of human immunodeficiency virus in cervicovaginal secretions. Am J Obstet Gynecol 2004;192:774-9

COPYRIGHT 2005 American Academy of Family Physicians

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