Bacterial vaginosis and susceptibility to HIV infection in South African women: a nested case-control study.
BACKGROUND
Bacterial vaginosis (BV) may increase women's susceptibility to HIV infection, but there are few prospective data.


METHODS
During follow-up for up to 36 months, 86 new HIV seroconverters (case patients) were identified among 5110 women enrolled in a cervical cancer screening trial. Nonseroconverting control subjects (n=324) were frequency matched to case patients by age and duration of follow-up. At enrollment, case patients and control subjects were evaluated for clinical signs of BV, and Gram stains of vaginal fluid were scored using Nugent criteria.


RESULTS
BV was diagnosed on the basis of clinical criteria at enrollment in 20% of seroconverters and 16% of control subjects (summary odds ratio [OR], 1.31 [95% confidence interval {CI}, 0.71-2.41]). Nugent criteria for BV were met by 74% of seroconverters and 62% of control subjects. Diagnosis of BV on the basis of Nugent criteria was significantly associated with an increased risk of HIV seroconversion, after adjustment for demographic characteristics, other sexually transmitted infections, and sexual behaviors (adjusted OR, 2.01 [95% CI, 1.12-3.62]).


CONCLUSIONS
BV may account for a substantial fraction of new HIV infections in this setting. Treatment of BV and other interventions to promote normal vaginal flora warrant attention for HIV prevention.
Myer
Landon
L
Infectious Diseases Epidemiology Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Denny
Lynette
L
Telerant
Robin
R
Souza
Michelle de
Md
Wright
Thomas C
TC
Kuhn
Louise
L
D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004198:Disease Susceptibility / Q000382:microbiology*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D015528:HIV Seroprevalence / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D013019:South Africa; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000150:complications*