Sex Differences in CMV Replication and HIV Persistence During Suppressive ART

Area of Science:

• Virology
• Immunology
• Infectious Diseases

Background:

• Subclinical cytomegalovirus (CMV) replication's link to HIV persistence is understudied in cis-gender women.
• Understanding co-infections in women living with HIV is crucial for managing viral persistence.

Purpose of the Study:

• To investigate the association between subclinical CMV replication and HIV persistence in cis-gender women with HIV.
• To compare CMV DNA and HIV RNA levels between women and men living with HIV.

Main Methods:

• Prospective enrollment of 50 virologically suppressed women with HIV.
• Quantification of CMV DNA and HIV DNA/RNA in oral, vaginal, urine, and blood samples using real-time and droplet digital PCR.
• Comparison with historical data from 49 men with HIV and CMV.

Main Results:

• Women with HIV showed lower detectable multiply-spliced HIV RNA and CMV DNA compared to men.
• CMV DNA presence was not associated with increased HIV DNA in women, unlike in men.
• Premenopausal status in women was independently associated with lower HIV DNA levels.

Conclusions:

• Women with HIV exhibited reduced cellular HIV RNA and less subclinical CMV DNA than men, with similar overall HIV DNA.
• Postmenopausal status emerged as an independent predictor of higher HIV DNA levels among women with HIV.