The association between Mycoplasma genitalium and HIV-1 acquisition in African women.
OBJECTIVE
Mycoplasma genitalium is an emerging sexually transmitted infection (STI) and has been associated with reproductive tract infections and HIV in cross-sectional studies. In this longitudinal study, we assess whether M. genitalium is associated with risk of acquiring HIV-1 infection.


METHODS
Nested case-control study within a large prospective study in Zimbabwe and Uganda


METHODS
A total of 190 women who seroconverted to HIV-1 during follow-up (cases) were matched with up to two HIV-negative controls. Mycoplasma genitalium testing was performed by PCR-ELISA, using archived cervical samples from the HIV-1 detection visit and the last HIV-negative visit for cases, and equivalent visits in follow-up time for controls. Risk factors for HIV-1 acquisition were analyzed using conditional logistic regression, with M. genitalium as the primary exposure.


RESULTS
Mycoplasma genitalium was a common infection in these populations (14.8 and 6.5% prevalence among cases and controls, respectively, at the visit prior to HIV-1 detection), and more prevalent than other nonviral STIs. We found a greater than two-fold independent increased risk of HIV-1 acquisition among women infected with M. genitalium at the visit prior to HIV-1 acquisition [adjusted odds ratio (AOR) = 2.42; 95% confidence interval (CI) 1.01-5.80), and at time of HIV-1 acquisition (AOR = 2.18; 95% CI 0.98-4.85). An estimated 8.7% (95% CI 0.1-12.2%) of incident HIV-1 infections were attributable to M. genitalium.


CONCLUSIONS
This is the first longitudinal study to assess the relationship between M. genitalium and HIV-1 acquisition. If findings from this research are confirmed, M. genitalium screening and treatment among women at high risk for HIV-1 infection may be warranted as part of an HIV-1 prevention strategy.
Women's Global Health Imperative, RTI International, San Francisco, California 94104, USA. smavedzenge@rti.org
Sue Napierala
SN
Mavedzenge
Barbara
B
Van Der Pol
Helen A
HA
Weiss
Cynthia
C
Kwok
Fidelis
F
Mambo
Tsungai
T
Chipato
Ariane
A
Van der Straten
Robert
R
Salata
Charles
C
Morrison
D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D008137:Longitudinal Studies; D009175:Mycoplasma Infections / Q000150:complications / Q000453:epidemiology*; D045704:Mycoplasma genitalium / Q000302:isolation & purification*; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012307:Risk Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology