The associations between cervicovaginal HIV shedding, sexually transmitted diseases and immunosuppression in female sex workers in Abidjan, Côte d'Ivoire

Objective:
To measure the frequency and associated factors of cervicovaginal HIV shedding and to determine the impact of sexually transmitted disease (STD) treatment on HIV shedding.

Design:
Cross-sectional study with 1-week follow-up.

Setting:
Confidential clinic for female sex workers in Abidjan, Côte d'Ivoire.

Participants:
A total of 1201 female sex workers.

Interventions:
STD treatment based on clinical signs.

Main outcome measures:
HIV serostatus; cervicovaginal HIV shedding at enrolment and at 1-week follow-up; STD status at enrolment and at 1-week follow-up.

Results:
Cervicovaginal shedding of HIV-1 in HIV-1-seropositive women was more frequent (96 out of 404, 24%) than shedding of HIV-2 in HIV-2-seropositive women [one out of 21, 5%; odds ratio (OR), 6.2; 95% confidence interval (CI), 1.0–261]. Among 609 HIV-1-seropositive or dually seroreactive women, HIV-1 shedding was significantly more frequent in immunosuppressed women [adjusted OR (AOR), 6.3; 95% CI, 3.4–11.9; and AOR, 2.9; 95% CI, 1.6–5.0 for CD4 < 14% and CD4 14–28%, respectively, versus CD4 > 28%], and in women with Neisseria gonorrhoeae (AOR, 1.9; 95% CI, 1.2–3.0), those with Chlamydia trachomatis (AOR, 2.5; 95% CI, 1.1–5.8), and with a cervical or vaginal ulcer (AOR, 3.9; 95% CI, 2.1–7.4). HIV-1 shedding decreased from 42 to 21% (P < 0.005) in women whose STD were cured.

Conclusions:
These data help to explain the difference in transmissibility between HIV-1 and HIV-2 and the increased infectiousness of HIV in the presence of immunosuppression and STD. In addition, they lend biological plausibility to arguments for making STD control an integral part of HIV prevention strategies in Africa.