title: The relative contribution of viral and bacterial sexually transmitted infections on HIV acquisition in southern African women in the Methods for Improving Reproductive Health in Africa study.
abstract: We assess the relative contribution of viral and bacterial sexually transmitted infections (STIs) on HIV acquisition among southern African women in a nested case-control study within the Methods for Improving Reproductive Health in Africa (MIRA) trial. Cases were women with incident HIV infection; controls were HIV-uninfected at the time of case seroconversion selected in a 1 to 3 case to control ratio (risk-set sampling), matched on study site and time of follow-up. Conditional logistic regression models were used to calculate adjusted odds ratios (AORs) and population-attributable fractions (PAF). Among 4948 enrolled women, we analysed 309 cases and 927 controls. The overall HIV incidence rate was 4.0 per 100 women-years. The incidence of HIV infection was markedly higher in women who had prevalent Herpes simplex virus type 2 (HSV-2) (AOR: 2.14; 95% confidence interval [CI]: 1.55-2.96), incident HSV-2 (AOR: 4.43; 95% CI: 1.77-11.05) and incident Neisseria gonorrhoeae (AOR: 6.92; 95% CI: 3.01-15.90). The adjusted PAF of HIV incidence for prevalent HSV-2 was 29.0% (95% CI: 16.8-39.3), for incident HSV-2 2.1% (95% CI: 0.6-3.6) and for incident N. gonorrhoeae 4.1% (95% CI: 2.5-5.8). Women's greatest risk factors for HIV acquisition were incident bacterial and viral STIs. Women-centred interventions aimed at decreasing HIV incidence in young African women need to address these common co-morbid conditions.
authors.affiliation: Department of Community Health, Division of Infectious Diseases, Brown University, Providence, RI 02912, USA. Kartik_Venkatesh@brown.edu
authors.forename: K K
authors.initials: KK
authors.lastname: Venkatesh
authors.forename: A
authors.initials: A
authors.lastname: van der Straten
authors.forename: H
authors.initials: H
authors.lastname: Cheng
authors.forename: E T
authors.initials: ET
authors.lastname: Montgomery
authors.forename: M N
authors.initials: MN
authors.lastname: Lurie
authors.forename: T
authors.initials: T
authors.lastname: Chipato
authors.forename: G
authors.initials: G
authors.lastname: Ramjee
authors.forename: K
authors.initials: K
authors.lastname: Blanchard
authors.forename: N S
authors.initials: NS
authors.lastname: Padian
authors.forename: K H
authors.initials: KH
authors.lastname: Mayer
authors.forename: G
authors.initials: G
authors.lastname: de Bruyn
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D017280:Condoms / Q000706:statistics & numerical data; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data; D005260:Female; D006069:Gonorrhea / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006558:Herpes Genitalis / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control / Q000821:virology; D018258:Herpesvirus 2, Human; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D009344:Neisseria gonorrhoeae; D016017:Odds Ratio; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology