title: Bacterial vaginosis, HIV serostatus and T-cell subset distribution in a cohort of East African commercial sex workers:  retrospective analysis.
abstract: OBJECTIVE
  Although bacterial vaginosis is a known correlate of HIV infection, no previous studies have investigated whether women defined as HIV-exposed seronegative (HESN) are less likely to have bacterial vaginosis. Little is known about the effects of bacterial vaginosis on systemic immune activation associated with HIV+ serostatus.
  
  
  METHODS
  Cohort-based retrospective analysis of bacterial vaginosis in relation to HESN status, HIV+ serostatus and peripheral T-helper cells, with cross-sectional analysis of bacterial vaginosis in relation to peripheral T-regulatory cells (Tregs).
  
  
  METHODS
  Bacterial vaginosis diagnosis by Gram stain and determination of systemic CD4(+) and CD8(+) T-helper cell frequency by flow cytometry for 3504 vaginal samples from 988 commercial sex workers over 4 years. Treg phenotyping by FoxP3 staining and multiparameter flow cytometry in peripheral blood of 97 women at a single time-point.
  
  
  RESULTS
  No differences in bacterial vaginosis diagnosis were observed between HESN and other HIV-negative (HIV-N) controls; however, HIV+ women were more likely to be diagnosed with bacterial vaginosis compared to all HIV-negative women (HESN/HIV-N combined). HIV+ women with bacterial vaginosis had significantly higher CD4(+)/CD8(+) T-helper cell counts and a lower CD4/CD8 ratio, as well as fewer Tregs as a proportion of total T-helper cells, compared to bacterial vaginosis-negative women. The number of bacterial vaginosis diagnoses in this cohort has decreased significantly over time.
  
  
  CONCLUSIONS
  Bacterial vaginosis is associated with HIV serostatus and shifts in distribution of T-cell subsets. A concomitant reduction in bacterial vaginosis and HIV infections over time suggests that the elucidation of bacterial vaginosis-HIV interactions will be critical to further understanding of HIV pathogenesis and prevention in this high-risk group.
authors.affiliation: Department of Medical Microbiology, Faculty of Medicine, University of Manitoba, Winnipeg, Canada. schellej@cc.umanitoba.ca
authors.forename: John J
authors.initials: JJ
authors.lastname: Schellenberg
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Card
authors.forename: T Blake
authors.initials: TB
authors.lastname: Ball
authors.forename: Jane Njeri
authors.initials: JN
authors.lastname: Mungai
authors.forename: Erastus
authors.initials: E
authors.lastname: Irungu
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
authors.forename: Walter
authors.initials: W
authors.lastname: Jaoko
authors.forename: Charles
authors.initials: C
authors.lastname: Wachihi
authors.forename: Keith R
authors.initials: KR
authors.lastname: Fowke
authors.forename: Francis A
authors.initials: FA
authors.lastname: Plummer
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology* / Q000276:immunology / Q000382:microbiology*; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D018023:HIV Seronegativity / Q000276:immunology; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data; D016176:T-Lymphocyte Subsets; D014621:Vagina / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000453:epidemiology* / Q000382:microbiology