HIV Shedding in Cervico-Vaginal Secretions in Pregnant Women

Objective: The purpose of this study was to evaluate the presence of HIV-1 in cervico-vaginal secretions of pregnant as compared to non-pregnant HIV-seropositive women. Patients and Methods: We compared 43 known HIV seropositive pregnant patients versus 241 age-matched (+/- 2 years) control non-pregnant HIV-seropositive subjects. In pregnant patients blood and cervico-vaginal samples were obtained during each trimester of pregnancy. In control subjects the same samples were obtained at enrolment. HIV-1 RNA was measured in plasma; proviral HIV-1 DNA, cell-associated and cell-free HIV-1 RNA in cervico-vaginal secretion by competitive polymerase chain reaction (cRT-PCR) and reverse transcriptase PCR. Results: The genital shedding of HIV-DNA (22/43 as compared to 79/241, p = 0.02), and cell-free HIV-RNA detection (26/43 as compared to 72/241, p <. 001) was more common in first-trimester pregnant than in non pregnant women. Pregnancy correlated with a significant positive trend in the cervico-vaginal load of HIV-DNA (Spearman Rho = 0.149, p = 0.012), and cell-free HIV-RNA (Spearman Rho = 0.253, p <. 001), but not of HIV-RNA transcripts (Spearman Rho = 0.06, p = 0.31). After correction for potential confounders, first trimester pregnant women had increased rates of genital HIV-DNA (odds ratio = 1.94, 95% confidence interval = 1.01 -3.78) and cell-free HIV-RNA (odds ratio = 4.07, 95% confidence interval = 1.97 - 8.41) detection compared to nonpregnant controls. Conclusion: The shedding of genital HIV was increased in pregnant compared to non pregnant subjects, even in patients with undetectable viremia. In this low-risk HIV-positive population the risks of vertical or horizontal transmissions should not be underestimated.