title: Association between Mycoplasma genitalium infection and HIV acquisition among female sex workers in Uganda: evidence from a nested case-control study.
abstract: OBJECTIVE
  Cross-sectional studies have shown a strong association between Mycoplasma genitalium and HIV infections. We previously reported that in a cohort of female sex workers in Uganda, M genitalium infection at baseline was associated with HIV seroconversion. Here we examine the temporal association between the M genitalium infection status shortly before HIV seroconversion and HIV acquisition.
  
  
  METHODS
  A nested case-control study was conducted within a cohort of women at high risk for HIV in Kampala. Cases were those of women acquiring HIV within 2 years of enrolment. For each of the 42 cases, 3 controls were selected from women HIV negative at the visit when the corresponding case first tested HIV seropositive. The association between HIV acquisition and M genitalium infection immediately prior to HIV testing was analysed using conditional logistic regression.
  
  
  RESULTS
  There was weak evidence of an association between M genitalium infection and HIV acquisition overall (crude OR=1.57; 95% CI 0.67 to 3.72, aOR=2.28: 95% CI 0.81 to 6.47). However, time of M genitalium testing affected the association (p value for effect-modification=0.004). For 29 case-control sets with endocervical samples tested 3 months prior to the first HIV-positive result, M genitalium infection increased the risk of HIV acquisition (crude OR=3.09; 95% CI 1.06 to 9.05, aOR=7.19; 95% CI 1.68 to 30.77), whereas there was little evidence of an association among the 13 case-control sets with samples tested at an earlier visit (crude OR=0.30: 95% CI 0.04 to 2.51; aOR=0.34; 95% CI 0.02 to 5.94).
  
  
  CONCLUSIONS
  Our study showed evidence of a temporal relationship between M genitalium infection and HIV acquisition that suggests that M genitalium infection may be a co-factor in the acquisition of HIV infection.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Judith
authors.initials: J
authors.lastname: Vandepitte
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Helen A
authors.initials: HA
authors.lastname: Weiss
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Justine
authors.initials: J
authors.lastname: Bukenya
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Nassim
authors.initials: N
authors.lastname: Kyakuwa
authors.affiliation: Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.
authors.forename: Etienne
authors.initials: E
authors.lastname: Muller
authors.affiliation: Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Buvé
authors.affiliation: Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium University of Ghent, Ghent, Belgium.
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
authors.affiliation: MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Hayes
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006679:HIV Seropositivity / Q000453:epidemiology*; D006801:Humans; D009175:Mycoplasma Infections / Q000453:epidemiology*; D045704:Mycoplasma genitalium; D012307:Risk Factors; D060386:Sex Workers / Q000706:statistics & numerical data*; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
keywords: AFRICA; EPIDEMIOLOGY (CLINICAL); GENITAL TRACT INFECT; HIV WOMEN; M GENITALIUM