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Published on: January 7, 2019
Sex Differences in CMV Replication and HIV Persistence During Suppressive ART
Sara Gianella1, Sarah McDonald Tran1, Sheldon Morris1
1University of California, San Diego, La Jolla, California, USA.
Insights
This study found that women with HIV had lower levels of cytomegalovirus (CMV) DNA and certain HIV RNA transcripts compared to men. Postmenopausal status was linked to higher HIV DNA in women.
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.
Background:
The association between subclinical cytomegalovirus (CMV) replication and HIV persistence has not been investigated in cis-gender women with HIV.
Methods:
Fifty virologically suppressed female participants with HIV were prospectively enrolled and provided oral, vaginal, and urine samples and peripheral blood mononuclear cells at 1 cross-sectional time point. CMV DNA was quantified in each specimen by real-time polymerase chain reaction (PCR). Cellular HIV DNA and HIV RNA transcripts (unspliced and multiply spliced [ms] encoding tat-rev) were quantified by droplet digital (dd) PCR in peripheral blood cells. Forty-nine male individuals with HIV and CMV (historical data) were used as controls.
Results:
Levels of cellular HIV DNA and unspliced HIV RNA were not different between sexes, but female participants had less detectable msHIV RNA and CMV DNA compared with males (both P < .01). Unlike previously described for males, the presence of CMV DNA was not associated with increased HIV DNA in females. Among female participants, premenopausal status was independently associated with lower HIV DNA compared with postmenopause, after adjusting for nadir CD4 count (P < .01).
Conclusions:
Female participants with HIV had reduced cellular HIV RNA and less subclinical CMV DNA compared with males but overall similar HIV DNA levels in our study. Postmenopausal status was independently associated with higher HIV DNA levels among female participants.
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