title: Vaginal colonization or infection with Candida albicans in human immunodeficiency virus-infected women during pregnancy and during the postpartum period. Women and Infants Transmission Study Group.
abstract: We evaluated the relationship between immunologic status and vaginal colonization or infection with Candida albicans for 605 women enrolled in a multicenter, prospective cohort study of mother-to-infant transmission of human immunodeficiency virus type 1 (HIV-1). A low CD4+ lymphocyte level (< 14% vs. > or = 14%, which corresponds to an absolute count of approximately 200 x 10(6)/L) was associated with a two- to fivefold increased likelihood of vaginal colonization (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.01-5.19) and vaginal candidiasis (OR, 3.08; 95% CI, 1.21-7.71) during pregnancy and during the postpartum period (OR, 2.98; 95% CI, 1.51-5.88 and OR, 5.45; 95% CI, 1.73-16.6, respectively). These associations persisted in multivariate logistic regression analyses. No associations with CD8+ lymphocyte levels or CD8+ CD38+ or other lymphocyte subset levels were found after adjustment for CD4+ cell level and other covariates. However, postpartum (but not antepartum) antibiotic use and pregnancy were also associated with vaginal colonization and candidiasis (P < or = .001 for each). Vaginal candidiasis was not associated with an increased risk of mother-to-infant transmission of HIV-1; however, a related, more inclusive variable, clinical vaginitis or vaginosis of any etiology at the last antepartum visit, was associated with mother-to-infant transmission (OR, 1.92; 95% CI, 1.07-3.43). These findings emphasize the complex, multifactorial nature of vaginal candidiasis and highlight the need for safe and effective treatment and prevention strategies for women with advanced HIV infection.
authors.affiliation: Pediatric, Adolescent, and Maternal AIDS Branch, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-7510, USA.
authors.forename: D N
authors.initials: DN
authors.lastname: Burns
authors.forename: R
authors.initials: R
authors.lastname: Tuomala
authors.forename: B H
authors.initials: BH
authors.lastname: Chang
authors.forename: R
authors.initials: R
authors.lastname: Hershow
authors.forename: H
authors.initials: H
authors.lastname: Minkoff
authors.forename: E
authors.initials: E
authors.lastname: Rodriguez
authors.forename: C
authors.initials: C
authors.lastname: Zorrilla
authors.forename: H
authors.initials: H
authors.lastname: Hammill
authors.forename: J
authors.initials: J
authors.lastname: Regan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D002176:Candida albicans / Q000302:isolation & purification*; D002181:Candidiasis, Vulvovaginal / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D011645:Puerperal Infection / Q000209:etiology*; D014621:Vagina / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents