Epidemiological synergy of Trichomonas vaginalis and HIV in Zimbabwean and South African women.
BACKGROUND
Trichomonas vaginalis (T. vaginalis) is the most common nonviral sexually transmitted infection in the world. Despite the coexisting global epidemics of T. vaginalis and HIV, little attention has focused on the emerging evidence that T. vaginalis increases susceptibility to, and potentially transmission of, HIV.


METHODS
We evaluated T. vaginalis infection in the context of a multisite, randomized controlled trial amongst women in South Africa and Zimbabwe, to determine first, if risk of HIV acquisition was increased among women recently infected with T. vaginalis, and second, if risk of T. vaginalis acquisition was increased among women infected with HIV.


RESULTS
After controlling for potential confounders, participants infected with T. vaginalis were more likely to test positive for HIV at their following visit, compared to participants uninfected with T. vaginalis (adjusted hazard ratio = 2.05; 95% CI, 1.05-4.02). Similarly, HIV-positive participants were twice as likely to have acquired T. vaginalis infection at the following visit, compared to HIV-negative participants (adjusted hazard ratio = 2.12; 95% CI, 1.35-3.32).


CONCLUSIONS
We found an increased risk of both HIV acquisition associated with T. vaginalis infection and risk of T. vaginalis acquisition associated with HIV infection. This bidirectional relationship represents a potentially important factor in sustaining the HIV epidemic in populations where T. vaginalis is endemic.
Mavedzenge
Sue Napierala
SN
Department of Epidemiology and Population Health, London, United Kingdom. sue.mavedzenge@lshtm.ac.uk <sue.mavedzenge@lshtm.ac.uk>
Pol
Barbara Van Der
BV
Cheng
Helen
H
Montgomery
Elizabeth T
ET
Blanchard
Kelly
K
de Bruyn
Guy
G
Ramjee
Gita
G
Straten
Ariane van der
Av
D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity; D006801:Humans; D008297:Male; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000150:complications / Q000453:epidemiology* / Q000469:parasitology / Q000517:prevention & control; D014246:Trichomonas vaginalis / Q000472:pathogenicity; D014622:Vaginal Creams, Foams, and Jellies / Q000008:administration & dosage; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
D014622:Vaginal Creams, Foams, and Jellies