V-3535. Hormonal Contraception is Associated with a Reduction in the Endogenous Anti-HSV Activity in the Genital Tract and Correlates with a Loss in Defensins and Other Protective Proteins
Session: Poster Session: Herpes Viruses
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: Cervicovaginal lavage (CVL) fluid protects against HSV, HIV & bacteria. Individual variation in this antimicrobial activity & its modulation by reproductive hormones has not been evaluated, nor have the protective mediators been characterized. This pilot study compared anti-HSV activity & levels of immune mediators in CVL obtained from women with normal ovulatory cycles (C) & women using hormonal contraception (HC). Methods: CVL was collected weekly from healthy women ages 22-33 yrs, analyzed for anti-HSV activity & levels of immune mediators. Women were excluded at any visit if they developed an STI. Results: 16 women (9 C & 7 HC) completed between 3 and 8 visits. When mean values obtained from repeat CVL from each woman were compared, HC had significantly decreased anti-HSV activity compared to C in the follicular phase (p=0.03) & trended towards reduced activity compared to the luteal phase (p=0.11). When fluid from each visit was analyzed as a discreet data point (n=94), the differences in anti-HSV activity in HC differed from that of C at both phases (K-W, p=0.0002). Anti-HSV activity positively correlated with levels of HNP 1-3 (Spearman r=0.45), lactoferrin (r=0.52), lysozyme (r=0.58) & IgA (r=0.44) & inversely with IFNα2 (r=-0.36) (all p < 0.0001). Conclusions: Despite the intra- & inter-subject variability in endogenous anti-HSV activity in CVL, there is a significant loss in activity among HC, which is associated with a reduction in protective mucosal mediators. Further study of the factors that modify this activity is ongoing. These findings may provide a biological explanation for the epidemiological findings of increased risk for STI & HSV shedding in the setting of hormonal contraception & suggest that larger prospective studies are needed.
Betsy Herold, MD1, Esmerelda Guzman2, Gail Shust, MD1, Hillel Cohen, PHD2, Margaret Pollack2, Marla Keller, MD1, Mathew Hazen, MD2, Rebecca Madan, MD2, Sylvia Cho, BS3 and  G. F. Shust, None., (1)Mount Sinai School of Medicine, New York, NY, (2)Albert Einstein College of Medicine, (3)Pediatrics, Division of Pediatric Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY

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