Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women.
OBJECTIVE
To evaluate interrelationships between bacterial vaginosis (BV), vaginal yeast, vaginal practices (cleansing and drying/tightening), mucosal inflammation, and HIV acquisition.


METHODS
A multicenter, prospective, observational cohort study was conducted, enrolling 4531 HIV-negative women aged 18 to 35 years attending family planning clinics in Zimbabwe and Uganda. Participants were tested for HIV and reproductive tract infections and were interviewed about vaginal practices every 3 months for 15 to 24 months. BV was measured by Gram stain Nugent scoring, vaginal yeast by wet mount, and mucosal inflammation by white blood cells on Gram stain.


RESULTS
HIV incidence was 4.12 and 1.53 per 100 woman-years of follow-up in Zimbabwe and Uganda, respectively (a total of 213 incident infections). Women with BV or vaginal yeast were more likely to acquire HIV, especially if the condition was present at the same visit as the new HIV infection and the visit preceding it (hazard ratio [HR] = 2.50, 95% confidence interval [CI]: 1.68 to 3.72 and HR = 2.97, 95% CI: 1.67 to 5.28 for BV and yeast, respectively). These relationships did not seem to be mediated by mucosal inflammation. Vaginal drying/tightening was associated with HIV acquisition in univariate (HR = 1.49, 95% CI: 1.03 to 2.15) but not multivariate models. Vaginal cleansing was not associated with HIV acquisition.


CONCLUSIONS
BV and yeast may contribute more to the HIV epidemic than previously thought.
Academic Medical Center, Center for Poverty-Related Communicable Diseases, Amsterdam, The Netherlands. j.vandewijgert@amc-cpcd.org
Janneke H H M
JH
van de Wijgert
Charles S
CS
Morrison
Peter G A
PG
Cornelisse
Marshall
M
Munjoma
Jeanne
J
Moncada
Peter
P
Awio
Jing
J
Wang
Barbara
B
Van der Pol
Tsungai
T
Chipato
Robert A
RA
Salata
Nancy S
NS
Padian
D000163:Acquired Immunodeficiency Syndrome / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000349:Africa; D002181:Candidiasis, Vulvovaginal / Q000150:complications*; D015331:Cohort Studies; D005260:Female; D015497:HIV-1; D006801:Humans; D014621:Vagina / Q000382:microbiology; D044364:Vaginal Douching; D016585:Vaginosis, Bacterial / Q000150:complications*