Increased Levels of HIV-1-Infected Cells in Endocervical Secretions After the Luteinizing Hormone Surge

Hormonal contraceptives have been implicated as cofactors for HIV-1 acquisition and genital virus shedding.1 Recently, we reported cyclic fluctuations in HIV-1 RNA levels in endocervical specimens, implying that normal hormonal fluctuations during the menstrual cycle have an impact on genital virus sampling, shedding, or both.2 In this study, HIV-1 RNA levels were significantly associated with the number of days from the midcycle luteinizing hormone (LH) surge and were minimal at midcycle and increased during the luteal phase. Similar patterns of HIV-1 RNA shedding in the female genital compartment have been reported,3,4 although others have found no association.5,6 It is unclear whether increased HIV-1 RNA levels reflect changes in the number of infected cells or increased viral expression in some infected cells. This distinction may be relevant to the risk of infectivity, given recent data suggesting a stronger association for HIV-1–infected cell number than HIV-1 RNA level in the context of vertical transmission.7 Infected cells may also play a critical role in sexual transmission of HIV-1, although this relation has not yet been examined. One previous analysis found no association between the menstrual cycle and HIV-1 DNA detection;8 however, to date, there has not been a quantitative analysis of changes in HIV-1–infected cell numbers during the menstrual cycle. Here, we examined the relation between the menstrual cycle and daily changes in the number of HIV-1–infected cells in endocervical secretions.