Directors' Choice

Sidebar

Your papers could be selected as the Directors' Choice, too, if you correctly acknowledge the SD CFAR grant number and if your paper has a PubMed Central ID (PMCID)

April 2022

Morris S, Cottrell M, Rawlings SA, Peterson S, Karris M, Pacheco D, Chaillon A, Kay A, Chow K, Anderson PL, Gianella S, Blumenthal J. Morris S, Cottrell M, Rawlings SA, Peterson S, Karris M, Pacheco D, Chaillon A, Kay A, Chow K, Anderson PL, Gianella S, Blumenthal J. Genital inflammation is not associated with decreased vaginal tenofovir concentrations in women taking oral PrEP. J Acquir Immune Defic Syndr. 2022;89(4):390-395. doi:10.1097/QAI.0000000000002884; PMID35202047; PMC8887788.

About This Paper

Background: We evaluated the association of inflammation and dysbosis on cervicovaginal fluid (CVF) tenofovir (TFV) concentrations in women taking oral tenofovir disoproxil fumarate/emtricitable for HIV pre-exposure prophylaxis (PrEP) in the United States.

Setting: Thirty-five women in a HIV PrEP implementation study attended their week 24 visit at a San Diego research clinic and provided CVF specimens.

Methods: Women in the Adherence Enhancement Guided by Individualized Texting and Drug Levels study had their CVF specimens evaluated for (1) sexually transmitted bacterial (Neisseria gonorrhoeae, Chlamydia trachomatis, Gardnerella, and Trichomonas vaginalis), viral (human papillomavirus, cytomegalovirus and herpes simplex virus-1/2) and fungal (Candida) infections; (2) microbiome composition by 16 S sequencing (V3-V4 region); and (3) cytokine profiles by enzyme-linked immunoassay (Interleukin-8, macrophage Inflammatory protein-1a, macrophage Inflammatory Protein-1b and interferon-?-inducible protein-10). Univariate statistical analysis was used to determine factors associated with CVF TFV concentrations. CVF TFV of 100-1000 ng/mL benchmarked typical genital concentrations and TFV-diphosphate in dried blood spots of 700 fmol/punch was considered adequate adherence.

Results: Thirty-five women had CVF specimens collected. No factor was associated with CVF TFV concentrations or discordance of blood and vaginal concentrations. Among 27 participants assessed for vaginosis (Candida, Gardnerella or Trichomonas), women with Gardnerella (n = 11) were more likely to have high (>1000 ng/mL) CVF TFV concentrations (82% versus 33%, P = 0.02).

Conclusions: Presence of genital viruses, cytokines, or vaginal community state types were not associated with low CVF TFV concentrations in cisgender women taking oral tenofovir disoproxil fumarate/emtricitable for PrEP. The surprising association observed between presence of Gardnerella and higher vaginal TFV concentrations needs further evaluation.

View other Directors' Choice selections from  201620172018201920202021, and 2022.

At a Glance