Background: Highly active antiretroviral therapy (HAART) could decrease HIV-1 transmissibility by reducing genital and plasma HIV-1 RNA.
Methods: We evaluated the effect of HAART on genital and plasma HIV-1 RNA in a cohort of 39 antiretroviral-naïve women in Burkina Faso. Cervico-vaginal lavages were collected before HAART initiation and at six visits over 28 weeks while on HAART. Blood samples were collected at baseline and at three and four visits for CD4 and plasma HIV-1 RNA measurements, respectively.
Results: Before HAART, 72% of women had detectable genital HIV-1 RNA. After 18 weeks on HAART, only one woman (2.5%) had detectable plasma HIV-1 RNA and two women (5.1%) had detectable genital HIV-1 RNA. Similar results were observed at each follow-up visit. However, 16/34 (47%) women with consistently undetectable plasma HIV-1 RNA shed HIV-1 at least once between weeks 18 and 28. In samples with detectable genital HIV-1, the mean quantity of HIV-1 RNA decreased from 3.87 prior to HAART to 3.04 log10 copies/mL at last visit (median 29 weeks; a 6.8-fold decrease in absolute number of copies/mL) (p = 0.04). A significant median CD4 lymphocyte cell gain of 121 cells/μL (interquartile range 59 to 204) was measured between pre-HAART and last visit.
Conclusion: These findings suggest that HAART could play a role in reducing HIV transmission in Africa; however, they underscore the need to emphasise safe sex practices with patients taking HAART.
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Composition of the Yerelon study group: E Bahembera, A Berthe, M Coulibaly, M-C Defer, R Diallo, D Djagbare, I Konate, F Ky-Dama, G T M’Boutiki, N Meda, I Millogo, N Nagot, A Ouedraogo, D Ouedraogo, F Rouet, A Sanon, H Sawadogo, R Vallo and L Vergne (deceased January 2007) (Centre Muraz, Bobo-Dioulasso, Burkina Faso); P Mayaud, N Nagot and H A Weiss (London School of Hygiene and Tropical Medicine, London, UK); P Becquart, V Foulongne, M Segondy and P Van de Perre (Montpellier University Hospital, and UMR 145, Institute for Research and Development, University of Montpellier 1, Montpellier, France); J-B Andonaba and A Sawadogo (University Hospital of Bobo-Dioulasso, Burkina Faso).
Contributors: NN, PM and PV designed and coordinated the study; AO and NN implemented the study with IK, AS and MCD; AS and JBA were the HIV clinical experts. Laboratory analyses were conducted by MCD under the supervision of PV, HW was responsible for the statistical analysis with NN, RV and PM; the first draft of the manuscript was written by NN, PV and PM. All authors contributed significantly to the manuscript and approved the final version.
Funding: This study was sponsored by Agence Nationale de Recherches sur le SIDA et les Hepatites (ANRS), France, grant ANRS 1291 and ANRS 1285. Additional financial support was provided through the UK’s Department for International Development (DFID) funded Knowledge Programme on HIV/AIDS & STI of the London School of Hygiene and Tropical Medicine.
Competing interests: None.
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