Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition.
A prospective cohort study was conducted to examine the relationship between vaginal colonization with lactobacilli, bacterial vaginosis (BV), and acquisition of human immunodeficiency virus type 1 (HIV-1) and sexually transmitted diseases in a population of sex workers in Mombasa, Kenya. In total, 657 HIV-1-seronegative women were enrolled and followed at monthly intervals. At baseline, only 26% of women were colonized with Lactobacillus species. During follow-up, absence of vaginal lactobacilli on culture was associated with an increased risk of acquiring HIV-1 infection (hazard ratio [HR], 2.0; 95% confidence interval [CI], 1.2-3.5) and gonorrhea (HR, 1.7; 95% CI, 1.1-2.6), after controlling for other identified risk factors in separate multivariate models. Presence of abnormal vaginal flora on Gram's stain was associated with increased risk of both HIV-1 acquisition (HR, 1.9; 95% CI, 1.1-3.1) and Trichomonas infection (HR, 1.8; 95% CI, 1.3-2.4). Treatment of BV and promotion of vaginal colonization with lactobacilli should be evaluated as potential interventions to reduce a woman's risk of acquiring HIV-1, gonorrhea, and trichomoniasis.
Martin
H L
HL
Department of Medicine, University of Washington, Seattle, USA.
Richardson
B A
BA
Nyange
P M
PM
Lavreys
L
L
Hillier
S L
SL
Chohan
B
B
Mandaliya
K
K
Ndinya-Achola
J O
JO
Bwayo
J
J
Kreiss
J
J
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D006861:Hydrogen Peroxide / Q000378:metabolism; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D007778:Lactobacillus / Q000302:isolation & purification*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology / Q000469:parasitology; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology
D006861:Hydrogen Peroxide