HIV infection and female genital tract immunity

A recent article offers a systematic review of the literature concerning the influence of clinical characteristics (e.g. pregnancy or STI history) on female genital tract immunity to HIV. This review places itself against the background of an increasing shift in HIV research from systemic considerations relating to transmission of the infection – “the blood compartment” – to considerations to do with the female genital tract – “the genital compartment”. The current interest in microbicide products for vaginal use is an example. A difficulty encountered by research in this area is the way genital mucosal immunity can be expected to vary in response to a number of clinical characteristics – some of which relate to the patient, and others to the state of development of the HIV virus, where the patient is HIV infected. Failure to take proper account of this variation could, according to the authors, lead in certain cases to erroneous interpretation of results.
Patient clinical characteristics likely to impact on female genital immunity reviewed in this paper include: phase of menstrual cycle and menopause; pregnancy; methods of contraception, especially hormonal and combination hormonal; race; STI history. Impact of pregnancy has been shown to be important (incident rate ratio: 2.16%). Evidence on the impact of the menstrual cycle is inconclusive, though hormonal regulation causes many immunologic changes. Much the same can be said of the impact of hormonal contraception, which is an area which appears to be in particular need of further investigation. The importance of STI history is well established, though not all STI receive the same attention. Clinical characteristics deriving from HIV disease state include: marked viremia in new infections; the impact of prior HIV infection on acquisition of multiple strains; the mode of HIV infection (i.e. whether via genital tract of IVD use); the degree of penetration of ARV drugs into the lower genital tract. It emerges in the course of this review that some of these clinical parameters are understudied (e.g. hormonal contraceptives), or scarcely studied at all (e.g. menopause; combination hormonal contraceptives).
The main content of the article concerns clinical characteristics. This is preceded, however, by comments on the potential importance of sampling techniques and the assessment of mucosal immune responses, for which the authors refer the reader to Jespers V. Harandi et al., “Assessment of mucosal immunity to HIV-1”. The authors urge the importance of developing standard operating procedures in this area.

Brenna L. Anderson, Susan Cu-Uvin, “Clinical Parameters Essential to Methodology and Interpretation of Mucosal Responses”, American Journal of Reproductive Immunology, March 2011

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