Effect of trichomoniasis therapy on genital HIV viral burden among African women.
BACKGROUND
Our objective was to test the hypothesis that treatment for trichomoniasis among HIV-infected women not taking antiretrovirals in South Africa would be associated with decreased HIV genital shedding.


METHODS
HIV-infected women presenting for routine HIV care were screened for trichomoniasis using self-collected vaginal swabs with a rapid point-of-care immunochromatographic antigen test. Women testing positive were offered enrollment into a prospective cohort study, if they had documented HIV infection, were aged 18 to 50 years, and were not receiving antiretroviral therapy. Recent use of postexposure prophylaxis or antibiotic therapy, active genital ulcers, or systemic illness were exclusion criteria. Cervical swabs were collected for gonococcal and chlamydial testing, and those testing positive were excluded. Women were treated with directly observed oral therapy with 2 g of oral metronidazole. A follow-up visit was scheduled 1 month after therapy, and partner letters were provided. Paired cervical wicks and plasma were collected for viral load measurement.


RESULTS
In all, 557 women were screened. Sixty tested positive for trichomoniasis, 10 subsequently met exclusion criteria, and 4 were lost to follow-up. Of 46 women evaluated at follow-up, 37 (80.4%) were cured. Plasma viral load was not significantly different after therapy (P = 0.93). Genital tract viral load decreased by 0.5 log10 (P < 0.01). The mean genital tract viral load (log10) decreased from 4.66 (<3.52-6.46) to 4.18 (<3.52-6.48) (P < 0.01) after therapy.


CONCLUSIONS
Screening and treatment of vaginal trichomoniasis decrease genital shedding of HIV among South African women not receiving antiretrovirals at 1 month after therapy.
Department of Obstetrics and Gynecology, Women & Infants Hospital/Alpert Medical School at Brown University, Providence, RI 02905, USA. banderson@wihri.org
Brenna L
BL
Anderson
Cynthia
C
Firnhaber
Tao
T
Liu
Avril
A
Swarts
Maureen
M
Siminya
Jessica
J
Ingersoll
Angela M
AM
Caliendo
Susan
S
Cu-Uvin
D000293:Adolescent; D000328:Adult; D000981:Antiprotozoal Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage*; D008875:Middle Aged; D011446:Prospective Studies; D013019:South Africa / Q000453:epidemiology; D014247:Trichomonas Vaginitis / Q000175:diagnosis / Q000188:drug therapy*; D014246:Trichomonas vaginalis / Q000472:pathogenicity*; D014621:Vagina / Q000276:immunology / Q000821:virology*; D019562:Viral Load / Q000187:drug effects*; D017201:Virus Shedding / Q000187:drug effects*; D055815:Young Adult
D000981:Antiprotozoal Agents; D008795:Metronidazole