Genital tract infections, antiretroviral treatment and HIV-1 viral load in early postpartum women: : implications for sexual and breastfeeding HIV transmission

Maintaining viral suppression in the postpartum period is critical for preventing HIV transmission to sexual partners and breastfed infants. Despite systemic viral suppression, genital HIV shedding may still occur in some women. We examined the association between bacterial vaginosis (BV) and sexually transmitted infections (STIs) and genital HIV shedding in postpartum women. In this cross-sectional postpartum study, we hypothesised that BV and other genital tract infections would modulate HIV viral load (VL) in the genital tract. Postpartum women with HIV, aged < 25 years and within 3 months of delivery were enrolled at a research facility located in a a high HIV-prevalence area in Durban, South Africa. Using the NucliSENS® EasyQ® HIV-1 v2.0 assay and a modified Abbott Alinity m HIV-1 assay, HIV VLwas quantified in plasma and cervical vaginal lavage respectively. Stored vaginal swabs were tested for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. BV and other STIs including HSV-2, Syphilis, and HepBsAg, were tested for in real-time. Of 82 women, 41 (50.6%) tested positive for BV and 22 (27.2%) for any STIat a median timepoint of 6.7 weeks postdelivery (IQR 1.3, 13.7). Fourteen (63.6%) women testing positive for an STI and 31 (75.6%) positive for BV were asymptomatic. Using the the bioMérieux NucliSENS® EasyQ® HIV-1 v2.0 assay with a lower limit of detection (LLOD) of 10 HIV-1 RNA copies/mL, HIV-RNA was quantifiable in plasma of 25 (30.5%) women with a mean (SD) VL of 69 594 (153 330) copies/ml. HIV-RNA was detected in the genital tract of 9 (11%) women with a mean VL of 3503 copies/ml (range 146 –11 504 copies/ml). We observed a strong positive correlation between plasma and GT VL(r = 0.970). Of the 51 participants with undetectable plasma VL, one had a detectable GT VL of 173 copies/ml. None of the predominantly asymptomatic and untreated genital tract infections were associated with genital tract HIV-1 VL. Despite receipt of ART, a third of women in the early postpartum women were virally unsuppressed, and one in ten women had evidence of viral shedding in the genital tract. There was no evidence of an association between genital tract infections and genital tract viral shedding. Poor adherence to ART and other genital tract factors will need to be explored in larger studies. Not applicable.