title: Co-occurrence of Trichomonas vaginalis and bacterial vaginosis and vaginal shedding of HIV-1 RNA.
abstract: BACKGROUND
  Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.
  
  
  METHODS
  HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.
  
  
  RESULTS
  In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.
  
  
  CONCLUSIONS
  T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.
authors: From the *Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA; †Department of Public Health, University of Southern Mississippi, Hattiesburg, MS; Departments of ‡Microbiology, Immunology, and Parasitology and §Internal Medicine, Louisiana State University, New Orleans, LA; ¶Department of Medicine Education Programs, University of Mississippi Medical Center, Jackson, MS; ∥Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; and **Department of Biostatistics, Tulane School of Public Health and Tropical Medicine, New Orleans, LA.
authors: Danielle R
authors: DR
authors: Fastring
authors: Angela
authors: A
authors: Amedee
authors: Megan
authors: M
authors: Gatski
authors: Rebecca A
authors: RA
authors: Clark
authors: Leandro A
authors: LA
authors: Mena
authors: Judy
authors: J
authors: Levison
authors: Norine
authors: N
authors: Schmidt
authors: Janet
authors: J
authors: Rice
authors: Jeanette
authors: J
authors: Gustat
authors: Patricia
authors: P
authors: Kissinger
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D002181:Candidiasis, Vulvovaginal / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D015995:Prevalence; D012367:RNA, Viral / Q000378:metabolism*; D012725:Sexual Behavior; D014247:Trichomonas Vaginitis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D014246:Trichomonas vaginalis / Q000302:isolation & purification*; D014481:United States; D014505:Urban Population; D014621:Vagina / Q000382:microbiology; D019522:Vaginal Discharge / Q000382:microbiology; D016585:Vaginosis, Bacterial / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D019562:Viral Load; D017201:Virus Shedding
chemical_list: D012367:RNA, Viral