Kenya: Infection With Trichomonas Vaginalis Increases the Risk of HIV-1 Acquisition
February 2, 2007
In this prospective study, investigators hoped to determine whether Trichomonas vaginalis infection is associated with an increased risk of HIV-1 infection.
From February 1993 through March 2004, HIV-1-seronegative female sex workers at a city clinic in Mombasa, Kenya, were invited to participate in an open cohort study of risk factors for HIV infection. At baseline and follow-up, participants were interviewed to determine their medical, sexual, and gynecological history. Syndromic treatment was given for women with signs or symptoms of genital tract infection, pelvic inflammatory disease or vaginal discharge, according to Kenya Ministry of Health guidelines, or one week later for women whose tests indicated infection. HIV risk-reduction counseling and condoms were provided at every visit.
Of 1,579 HIV-negative women enrolled, 1,335 (85 percent) returned for follow-up, yielding a slightly younger cohort (25 years vs. 26 years; P=0.02) with less experience in sex work (0.8 vs. 1 year median; P=0.01). In the median duration of 566 days at last follow-up, there were 806 incident T. vaginalis infections and 265 HIV-1 seroconversions.
In univariate analyses, T. vaginalis infection was associated with a significant increase in HIV-1 seroconversion (hazard ratio [HR], 1.60; 95 percent confidence interval [CI], 1.11-2.31; P=0.01). After adjusting for sexual risk behaviors, STDs, and potential confounders, the association remained statistically significant (adjusted HR, 1.52 [95 percent CI, 1.04-2.24]; P=0.03).
Shorter duration of sex work, lower educational attainment, and use of alcohol were all significantly associated with T. vaginalis infection. It was also more common among those with concurrent cervicitis or concurrent bacterial vaginosis. Condom use and use of progesterone-only contraceptives (DMPA and Norplant) were associated with lower T. vaginalis infection risk, which held in multivariate analyses.
"Our finding associating this infection with increased risk of HIV-1 acquisition suggests interventions targeted toward preventing vaginal trichomoniasis could reduce the spread of HIV," concluded authors. "There is mounting evidence that other conditions that disrupt the normal vaginal milieu, including bacterial vaginosis and vaginal candidiasis, also increase susceptibility to HIV-1 acquisition?. Interventions to prevent and treat trichomoniasis and to improve vaginal health in general could provide important female-controlled methods for reducing the risk of HIV-1 transmission to women."
Journal of Infectious Diseases
03.2007; Vol. 195;doi:10.1086/511278; R. Scott McClelland; Laura Sangaré; Wisal M. Hassan; Ludo Lavreys; Kishorchandra Mandaliya; James Kiarie; Jeckoniah Ndinya-Achola, Walter Jaoko; Jared M. Baeten
Male Circumcision in Siaya and Bondo Districts, Kenya: Prospective Cohort Study to Assess Behavioral Disinhibition Following Circumcision
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.