HIV in the female genital tract: viral shedding and mucosal immunity.

Abstract

Considering that genital tract infection may be linked to mother-to-child transmission of HIV it is critical to gain a better understanding of HIV infection and mucosal immunity to HIV in the female genital tract. This paper summarizes existing knowledge of HIV infection and immunity in the female genital tract. Topics include the detection of HIV in the female genital tract correlates of HIV shedding impact of hormones and the menstrual cycle on HIV immunology of HIV infection HIV-mediated dysregulation of the immune system of the female genital mucosa correlates of protective immunity to HIV-1 sexual transmission and possible mediators of HIV infection. A notable conclusion is that after highly active antiretroviral therapy (HAART) both cervico-vaginal lavage (CVL) and systemic viral load can successfully be reduced. However to circumvent HIV transmission a long-lasting protective vaccine for both mucosal and systemic compartments is needed. Future vaccines should be designed and administered in mechanisms that will illicit not only systemic protection but also mucosal protection.