title: The influence of ART on the treatment of Trichomonas vaginalis among HIV-infected women.
abstract: OBJECTIVE
  Among women who are human immunodeficiency virus positive (HIV+), both prevalent and persistent infections with Trichomonas vaginalis (TV) are common. TV has been shown to increase vaginal shedding of HIV, which may influence HIV sexual and perinatal transmission, making prevention important. In 1 cohort of HIV+ women in Kenya, antiretroviral therapy (ART) use, mostly nevirapine based, was associated with lower cure rates of TV for single-dose therapy. Our goal was to repeat this study in a US-based cohort of HIV+/TV+ women and compare outcomes to those with multidose therapy.
  
  
  METHODS
  A secondary data analysis was performed on a multicentered cohort of HIV+/TV+ women who were randomized to single-dose (2 grams) or 7-day (500 mg twice daily) multidose metronidazole (MTZ) treatment. Test of cure visit, via culture, occurred 6-12 days after treatment completion. Information was collected on sex partner treatment and sexual exposures. Persistent TV infection rates were compared for women on ART at baseline vs not on ART.
  
  
  RESULTS
  Of the 226 women included, those on ART had more treatment failures than women not on ART (24/146 [16.4%] vs 5/80 [6.3%]; P = .03). When stratified by treatment arm, more treatment failures were seen in the single-dose arm (17/73 [23.3%] vs 3/39 [7.7%]; P = .05) than in the multidose arm (7/73 [9.6%] vs 2/41 [4.8%]; P = .39).
  
  
  CONCLUSIONS
  ART usage was associated with a higher TV persistent infection rate among those receiving the single-dose treatment, but not the multidose, providing more evidence that multidose should be the preferred treatment for HIV+ women.
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Alys
authors.initials: A
authors.lastname: Adamski
authors.affiliation: Department of Medicine, Louisiana State University, New Orleans.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Clark
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Leandro
authors.initials: L
authors.lastname: Mena
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson.
authors.forename: Harold
authors.initials: H
authors.lastname: Henderson
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Judy
authors.initials: J
authors.lastname: Levison
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Norine
authors.initials: N
authors.lastname: Schmidt
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Hirut T
authors.initials: HT
authors.lastname: Gebrekristos
authors.affiliation: Department of Medicine, Louisiana State University, New Orleans.
authors.forename: David H
authors.initials: DH
authors.lastname: Martin
authors.affiliation: Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
authors.forename: Patricia
authors.initials: P
authors.lastname: Kissinger
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D060085:Coinfection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome; D014247:Trichomonas Vaginitis / Q000188:drug therapy* / Q000469:parasitology; D014246:Trichomonas vaginalis; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D000981:Antiprotozoal Agents
keywords: HIV; Trichomonas vaginalis; antiretroviral; metronidazole