Original Research

Association between symptomatic vulvovaginal candidiasis and HIV RNA levels in plasma and genital secretions among women on HAART

Teke Apalata, William Henry Carr, Benjamin Longo-Mbenza, Willem Adrian Sturm, Prashini Moodley
Southern African Journal of HIV Medicine | Vol 15, No 2 | a21 | DOI: https://doi.org/10.4102/sajhivmed.v15i2.21 | © 2014 Teke Apalata, William Henry Carr, Benjamin Longo-Mbenza, Willem Adrian Sturm, Prashini Moodley | This work is licensed under CC Attribution 4.0
Submitted: 12 December 2014 | Published: 23 May 2014

About the author(s)

Teke Apalata, Department of Medical Microbiology and Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa, South Africa
William Henry Carr, HIV Pathogenesis Programme, Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa; Department of Biology, Medgar Evers College, The City University of New York, USA, United States
Benjamin Longo-Mbenza, Department of Medical Microbiology, Faculty of Health Sciences, Walter Sisulu University, Mthatha, Eastern Cape, South Africa, South Africa
Willem Adrian Sturm, Department of Medical Microbiology and Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South Africa
Prashini Moodley, Department of Medical Microbiology and Infection Prevention and Control, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, South Africa

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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<0.0001). Of the 42 women with detectable plasma HIV RNA, 12 (28.6%) had detectable genital HIV RNA. Plasma HIV RNA levels ranged from 2.5 (±0.8) to 4.1 (±0.8) log10 copies/ml. Genital HIV RNA levels ranged from 1.4 to 2.5 (±1.1) log10 copies/ml. The adjusted odds ratios of plasma HIV RNA levels increased for patients <35 years (p=0.039) and in those with VVC (p=0.008). Detectability of HIV in genital secretions was significantly increased in patients with a plasma HIV load ≥10 000 copies/ml (p=0.032) and genital absolute counts of neutrophils >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.


Keywords

HIV RNA; lower genital tract; plasma; PMN cells; symptomatic VVC; excess risk

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