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.
Design: 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.
Conclusion: 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.
aWomen's Global Health Imperative, RTI International, San Francisco, California, USA
bDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
cDivision of Epidemiology & Biostatistics, Indiana University School of Public Health, Bloomington, Indiana
dBiostatistics Department, FHI, Durham, North Carolina, USA
eAMPATH Reference Laboratory, Eldoret, Kenya
fUniversity of Zimbabwe, Harare, Zimbabwe
gCenter for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, California
hCase Western Reserve University, Cleveland, Ohio
iClinical Sciences, FHI, Durham, North Carolina, USA.
Correspondence to Sue Napierala Mavedzenge; Women's Global Health Imperative, RTI International, 114 Sansome Street, Suite 500, San Francisco, California 94104, USA. Tel: +1 415 848 1384; fax: +1 415 848 1377; e-mail: firstname.lastname@example.org
Received 26 August, 2011
Revised 31 October, 2011
Accepted 2 December, 2011