Abstract
Background. Genital tract (GT) inflammation plays a major role in HIV transmission. We aimed to determine the association between symptomatic vulvovaginal candidiasis (VVC) and HIV RNA levels in plasma and GTs of HIV-infected women on highly active antiretroviral therapy (HAART). Method. Women with VVC on HAART were recruited from a primary healthcare clinic in KwaZulu-Natal Province, South Africa, between June 2011 and December 2011. VVC was diagnosed clinically, supported by Gram staining and culture of genital secretions. HIV RNA load was determined by reverse transcription polymerase chain reaction. CD4+ counts were obtained from patients' medical records. Results. Plasma HIV RNA was detected in 42 of 60 (70%) patients on HAART. The mean duration (± standard deviation) on HAART for these patients was 4.2 (±1.6) months v. 10.7 (±1.4) months for the remaining 18 patients (p 10 cells/5 high microscopic fields (p=0.007). Conclusion. Given that the majority of women had recently initiated HAART (allowing a high rate of detectable plasma HIV RNA), there was insufficient evidence to conclude that VVC was predictive of high plasma HIV RNA levels. It is more likely that this cohort of immunosuppressed women were prone to develop VVC. Plasma HIV loads and local genital inflammation were predictors of genital HIV detectability.
Highlights
Genital tract (GT) inflammation plays a major role in HIV transmission
Cause and effect was difficult to unravel in the current study design, it seemed more likely that the observed higher level of immunosuppression among the study participants influenced the occurrence of vulvovaginal candidiasis (VVC)
Identified factors associated with HIV RNA loads in plasma and female genital secretions were consistent with previously published factors from the literature
Summary
Genital tract (GT) inflammation plays a major role in HIV transmission. We aimed to determine the association between symptomatic vulvovaginal candidiasis (VVC) and HIV RNA levels in plasma and GTs of HIV-infected women on highly active antiretroviral therapy (HAART). Plasma HIV RNA was detected in 42 of 60 (70%) patients on HAART. Plasma HIV RNA levels ranged from 2.5 (±0.8) to 4.1 (±0.8) log copies/ml. Genital HIV RNA levels ranged from 1.4 to 2.5 (±1.1) log copies/ml. The adjusted odds ratios of plasma HIV RNA levels increased for patients 10 cells/5 high microscopic fields (p=0.007). Given that the majority of women had recently initiated HAART (allowing a high rate of detectable plasma HIV RNA), there was insufficient evidence to conclude that VVC was predictive of high plasma HIV RNA levels. Plasma HIV loads and local genital inflammation were predictors of genital HIV detectability
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