Effect of hormonal contraceptive use on HIV progression in female HIV seroconverters in Rakai, Uganda
Polis, C.B.; Wawer, M.J.; Kiwanuka, N.; Laeyendecker, O.; Kagaayi, J.; Lutalo, T.; Nalugoda, F.; Kigozi, G.; Serwadda, D.; Gray, R.H.
Aids 24(12): 1937-1944
2010
ISSN/ISBN: 1473-5571 PMID: 20502312 DOI: 10.1097/aog.0b013e3181e45a6fDocument Number: 210449
The U.S. Food and Drug Administration has approved two devices for hysteroscopic tubal sterilization. To minimize the failure rates of these effective methods, it is important for health care providers to understand the important role hysterosalpingography (HSG) plays in any hysteroscopic tubal sterilization procedure. The purpose of this Committee Opinion is to emphasize the necessity of performing HSG 3 months after hysteroscopic tubal sterilization and to identify factors that may interfere with performance of an adequate HSG assessment. To investigate plasma levels of high mobility group box-1 protein (HMGB1), a marker of tissue necrosis and immune activation, as well as lipopolysaccharide (LPS), a marker of bacterial translocation, in HIV-1-infected patients. We studied 32 HIV-1-positive patients who had responded to antiretroviral therapy with undetectable viremia after 2 years, 10 nonresponders and 19 healthy controls. HMGB1 was analyzed by ELISA, and LPS by Lamilus colometric assay. Nonparametric statistics were applied. In naive HIV-1 patients, HMGB1 and LPS were elevated as compared with controls (P < 0.001). LPS levels were higher in African and Oriental patients compared with whites (P = 0.007). Notably, viral load was two-fold higher in patients with LPS, and HMGB1 was above median as compared with other patients (P = 0.005). This association was largely driven by African patients, who had a five-fold increased viral load in the presence of elevated LPS and HMGB1. After 2 years of effective antiretroviral therapy, LPS was reduced to the same median level as in the control group (P < 0.001), and HMGB1 was also reduced (P = 0.001), whereas no reductions were seen in nonresponders. The new findings are the association of elevated plasma levels of LPS and HMGB1 with high viral load, as well as the normalized levels of LPS, and the reduction of HMGB1 after 2 years of effective antiretroviral therapy. As LPS and HMGB1 tend to form immunologically active complexes in vitro, we propose that such complexes may be involved in the immune activation and pathogenesis of HIV-1 infection.