title: The influence of bacterial vaginosis on the response to Trichomonas vaginalis treatment among HIV-infected women.
abstract: OBJECTIVE
  Trichomonas vaginalis (TV) is common in HIV+ women, and host factors may play a role in TV treatment outcomes. The purpose of this study was to examine the influence of bacterial vaginosis (BV) on the response to TV treatment among HIV+ women.
  
  
  METHODS
  A secondary analysis was conducted of a clinical trial which randomised HIV+/TV+ women to metronidazole (MTZ) treatment: 2 g (single-dose) versus 7 day 500 mg twice daily (multidose). BV was classified using Nugent scores from baseline Gram stains. Women were recultured for TV at test-of-cure (TOC) and again at 3 months if TV-negative at TOC. Repeat TV infection rates were compared for women with a baseline TV/BV coinfection versus baseline TV infection only, and stratified by treatment arm.
  
  
  RESULTS
  Among 244 HIV+/TV+ women (mean age=40.3, ±9.5; 92.2% African-American), the rate of BV was 66.8%. Women with BV were more likely to report douching and ≥1 recent sex partners. HIV+ women with baseline TV/BV coinfection were more likely to be TV-positive at TOC than women with baseline TV infection only (RR 2.42 (95% CI 0.96 to 6.07; p=0.05)). When stratified by treatment arm, the association was only found in the single-dose arm (p=0.02) and not in the multidose arm (p=0.92). This interaction did not persist at 3 months.
  
  
  CONCLUSIONS
  For HIV+/TV+ women, the rate of BV was high, and BV was associated with early failure of the MTZ single-dose treatment for TV. Biological explanations require further investigation.
authors.affiliation: Tulane University School of Public Health and Tropical Medicine, Department of Epidemiology, New Orleans, LA 70112, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Gatski
authors.forename: David H
authors.initials: DH
authors.lastname: Martin
authors.forename: Judy
authors.initials: J
authors.lastname: Levison
authors.forename: Leandro
authors.initials: L
authors.lastname: Mena
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Clark
authors.forename: Mary
authors.initials: M
authors.lastname: Murphy
authors.forename: Harold
authors.initials: H
authors.lastname: Henderson
authors.forename: Norine
authors.initials: N
authors.lastname: Schmidt
authors.forename: Patricia
authors.initials: P
authors.lastname: Kissinger
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications*; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000150:complications / Q000188:drug therapy*; D014246:Trichomonas vaginalis; D016585:Vaginosis, Bacterial / Q000150:complications*
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole