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Antiretroviral adherence and development of drug resistance are the strongest predictors of genital HIV-1 shedding among women initiating treatment

Graham, S.M.; Masese, L.; Gitau, R.; Jalalian-Lechak, Z.; Richardson, B.A.; Peshu, N.; Mandaliya, K.; Kiarie, J.N.; Jaoko, W.; Ndinya-Achola, J.; Overbaugh, J.; McClelland, R.S.

Journal of Infectious Diseases 202(10): 1538-1542

2010

ISSN/ISBN: 1537-6613
PMID: 20923373
DOI: 10.1086/656790
Document Number: 218360
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.

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