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Increase in Endocervical CD4 Lymphocytes among Women with Nonulcerative Sexually Transmitted Diseases

Division of Sexually Transmitted Disease Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, and Fulton County Health Department, Atlanta, Georgia 30333, USA.
The Journal of Infectious Diseases (Impact Factor: 5.78). 01/1998; 177(1):167-74. DOI: 10.1086/513820
Source: PubMed

ABSTRACT To assess associations of nonulcerative sexually transmitted diseases (STDs) with human immunodeficiency virus (HIV)-susceptible leukocytes on female genital mucosa, cervicovaginal specimens from 32 HIV-negative STD clinic patients with gonorrhea, chlamydial infection, or trichomoniasis were compared with specimens from 32 clinic patients without these infections. Twenty-eight patients had single infections (15 gonorrhea, 10 chlamydial infection, 3 trichomoniasis), and 4 had dual infections. A saline vaginal wash and saline suspensions of vaginal wall scrapings, ectocervical scrapings, and endocervical brushings were analyzed by flow cytometry. Specimens from the endocervix had the highest proportions of lymphocytes, monocytes, and Langerhans' cells. The median number of endocervical CD4 lymphocytes/10,000 cells was greater among patients with STDs than among those without (476 vs. 245; P < .001). These data suggest that the endocervix may have a particularly important role in heterosexual HIV transmission and that nonulcerative STDs may facilitate HIV transmission by increasing the presence of CD4 lymphocytes at this site.

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    • "Gonorrhoea has consistently been identified as a risk factor for incident HIV infection in both heterosexual and MSM populations [5-7]. This is thought to result from increased HIV viral shedding in genital secretions [8,9] and from an increased concentration of target cells for HIV in the locally inflamed mucosa found in individuals with gonorrhoea [10]. Ensuring effective gonorrhoea testing and treatment is therefore important to both reduce the global incidence of curable sexually transmitted infections and control the spread of HIV. "
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    • "In this human study, we observed elevated levels of chemokines such as RANTES and MIP- 1␣ in endocervical secretions from C. trachomatis-positive women compared with post-treatment samples. Induction of these chemokines may contribute to the recruitment of endocervical CD4+ T cells found in women with C. trachomatis infection (Mittal et al., 2004; Ficarra et al., 2008; Levine et al., 1998). In the rhesus macaque model, in response to SIV challenges, the endocervical epithelium produces MIP-3␣ to recruit pDCs that produce cytokines (IFN␣) and chemokines (MIP-1␣ and MIP-1␤), leading to the migration of CCR5-expressing cells such as CD4+ T cells, which are SIV/HIV target cells (Li et al., 2009). "
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    • "This relatively low frequency of transmission can be explained by a continuum of variables extending from the properties of the infectious inoculum to the properties of the exposed mucosal surfaces. The presence of pre-existing sexually transmitted infections (STI) is widely believed to increase susceptibility to HIV-1 infection for exposed women, presumably by causing damage to mucosal surfaces and signaling the recruitment of inflammatory cell infiltrates [24], [25], [26], [27]. Several previous studies have described interactions between herpes simplex virus (HSV-1 or HSV-2) and HIV-1 [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38]. "
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