Vaginal Cytomegalovirus Shedding Before and After Initiation of Antiretroviral Therapy in Rakai,

Vaginal shedding of cytomegalovirus (CMV) DNA was deter-mined longitudinally among 96 women coinfected with human immunodeficiency virus (HIV), herpes simplex virus 2, and CMV starting antiretroviral therapy (ART) during a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Vaginal CMV was detected in 75 of 96 women (78.0%) and 379 of 1080 individual visits (35.1%). ART status, higher HIV RNAviral load before ART initiation, and younger age were significantly associated with increased frequency of CMV shedding (P <.01). Compared to pre-ART, CMV shedding peaked from month 2 to month 4 after ART initiation, suggesting possible immune reconstitution in-flammatory syndrome. Further studies need to determine the clinical significance of asymptomatic CMV shedding. Keywords. acyclovir; antiretroviral therapy (ART); cyto