Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study.
OBJECTIVE
To determine the natural history of bacterial vaginosis in women with or at risk for human immunodeficiency virus (HIV).


METHODS
A cohort of 854 HIV-infected women and 434 HIV-uninfected women from four US sites was followed prospectively with gynecologic exams every 6 months over a 5-year period. The prevalence, incidence, persistence, and severity of bacterial vaginosis, which was defined using a Gram-staining scoring system, were calculated using generalized estimating equation methods.


RESULTS
In adjusted analyses, HIV-infected women had a higher prevalence of bacterial vaginosis than HIV-uninfected women (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.08, 1.55). Although HIV-infected women were not more likely to have incident infections, they were more likely to have persistence of their infections (adjusted OR 1.49; 95% CI 1.18, 1.89). Similarly, immunocompromised women (CD4+ cell count less than 200 cells/microL) were more likely than HIV-infected women with higher CD4+ cell counts (more than 500 cells/microL) to have prevalent (adjusted OR 1.29; 95% CI 1.03, 1.60) and persistent (adjusted OR 1.38; 95% CI 1.01, 1.91) bacterial vaginosis infections, but not more likely to have incident infections. Immunocompromised women had more severe bacterial vaginosis by both clinical criteria (adjusted OR 1.40; 95% CI 1.08, 1.82) and by Gram-staining criteria (adjusted OR 1.50; 95% CI 1.12, 2.00).


CONCLUSIONS
Bacterial vaginosis is more prevalent and persistent among HIV-infected women, particularly among those who are immunocompromised. Immunocompromised women are more likely than HIV-infected women with higher CD4+ cell counts to have severe bacterial vaginosis.
Jamieson
D J
DJ
Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. djj0@cdc.gov
Duerr
A
A
Klein
R S
RS
Paramsothy
P
P
Brown
W
W
Cu-Uvin
S
S
Rompalo
A
A
Sobel
J
J
D017088:AIDS-Related Opportunistic Infections / Q000145:classification / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D018023:HIV Seronegativity; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology; D016585:Vaginosis, Bacterial / Q000145:classification / Q000150:complications / Q000453:epidemiology*