Dr. Heidi Jones, Professor at the CUNY Graduate School of Public Health and Health Policy, and colleagues compared sampling methods to measure HIV RNA viral load in female genital tract secretions. The findings were published in the American Journal of Reproductive Immunology.
[Photo: Dr. Heidi Jones]
The question posed by the research team was how does a menstrual cup compare to other genital sampling methods for HIV RNA recovery?
The research team compared HIV RNA levels between a menstrual cup, endocervical swab, and endocervical swab -enriched cervicovaginal lavage specimens in 51 HIV-positive, antiretroviral therapy-naive women at enrollment, 3 and 6 months, with order rotated by visit. The team used McNemar’s exact tests, signed-rank tests, and an extension of Somer’s D for pooled analyses across visits to analyze the paired comparisons.
In this study, among pairs of sufficient specimens, menstrual cup specimens yielded higher median levels of HIV RNA than endocervical swab-enriched cervicovaginal lavage or endocervical swab specimens, and endocervical swab-enriched cervicovaginal lavage specimens generally had higher levels than endocervical swab. Both menstrual cup and endocervical swab-enriched cervicovaginal lavage methods sampled a larger surface area of the lower reproductive tract than endocervical swab, which may explain why these specimens yielded higher HIV viral load than endocervical swab.
Conversely, there were higher levels of insufficient specimens in the menstrual cup compared to endocervical swab and endocervical swab-enriched cervicovaginal lavage across all visits. Correct placement of the menstrual cup may be harder to achieve than collection of cells from targeted sites using the endocervical swab-enriched cervicovaginal lavage and endocervical swab. The issue of insufficient specimen may be greater for HIV RNA testing as a relatively large specimen is required, as compared to other assays.
The menstrual cup appeared acceptable to most women, as only 6% reported difficulties with insertion, and, for each of these women, only at a single visit. Further, comfort level with the menstrual cup increased over time with women’s use experience. All of the women in this study were willing to self-insert the menstrual cup at enrollment.
In summary, endocervical swab-enriched cervicovaginal lavage and menstrual cup sampling are both superior to endocervical swab for HIV RNA detection and quantification and, if yield of sufficient specimens can be improved, menstrual cup may be superior to endocervical swab-enriched cervicovaginal lavage. Menstrual cup sample mass was generally greater, which may prove advantageous to studies where multiple assays are planned from the same sample. Menstrual cup sampling may also be completed by the patient herself, without provider time and associated cost.