Selection of Drug Resistant Variants in the Female Genital Tract of Human Immunodeficiency Virus Type 1-Infected Women Receiving Antiretroviral Therapy [Si-Mohamed A, et al. JID 2000; 182: 112]: This is a study of cervicovaginal secretions from 58 HIV-1-infected women. HIV RNA was detected in plasma samples from 74%, and it was significantly less common in cervicovaginal specimens in 39%. There was a correlation between plasma levels and cervicovaginal secretion levels with a mean reduction of 1.16 log copies/ml in cervicovaginal secretions. Of 40 women with HIV detected in serum, 19 (48%) had detectable virus in cervicovaginal secretions. Proviral DNA was detected in about half of cervicovaginal secretions regardless of concurrent presence of HIV RNA. HIV recovered in cervicovaginal secretions was frequently resistant to antiretroviral drugs even when plasma strains were sensitive. The authors concluded that antiretroviral therapy does not effectively purge the female genital tract of cell-associated provirus and antiretroviral drugs apply selective pressure on genital HIV strains.
Comment: This study, like the one above, emphasizes the difficult challenge with antiretroviral therapy in terms of compartmentalization of HIV and the persistence of this reservoir even when there is successful control of plasma viremia. posted 8/7/2000