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HIV-Inducing Factor in Cervicovaginal Secretions Is Associated With Bacterial Vaginosis in HIV-1-Infected Women

Cohn, Jonathan A MD*; Hashemi, Farhad B PhD; Camarca, Margaret MPH; Kong, Fanhui PhD; Xu, Jiahong MPH; Beckner, Suzanne K PhD; Kovacs, Andrea A MD§; Reichelderfer, Patricia S PhD; Spear, Gregory T PhD

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2005 - Volume 39 - Issue 3 - p 340-346
doi: 10.1097/01.qai.0000146599.47925.e0
Epidemiology and Social Science

Objective: Certain cervicovaginal lavage (CVL) fluid samples obtained from HIV-1-infected and uninfected women stimulate in vitro HIV-1 replication. This activity, HIV-inducing factor (HIF), changes when CVL fluid is heated. We sought to confirm a previous observation that HIF was associated with bacterial vaginosis (BV).

Methods: HIF was measured in unheated and heated CVL fluid obtained from HIV-1-infected women and compared with the presence of BV by Nugent scores, other genital tract conditions, and cervicovaginal HIV-1 shedding.

Results: Among the 295 women studied, 54% of CVL samples had HIF activity and 21% showed heat-stable HIF activity. In adjusted logistic regression, heat-stable HIF was associated with BV (odds ratio [OR] = 51.7, 95% confidence interval [CI]: 5.0, 530.7) and with intermediate flora (OR = 43.3, 95% CI: 3.6, 521.1); heat-labile HIF was not associated with BV. Neither heat-stable nor heat-labile HIF was associated with other cervicovaginal conditions nor, after controlling for plasma viral load, with genital tract HIV-1 shedding.

Conclusion: We confirmed the association of HIF with BV and attribute it to the heat-stable component. Heat-stable activity is also associated, although less strongly, with intermediate vaginal flora. We propose that heat-stable HIF is a result of products of BV-associated bacteria.

From the *Division of Infectious Diseases, Department of Medicine, Wayne State University School of Medicine, Detroit, MI; †Department of Immunology and Microbiology, Rush Presbyterian/St. Luke's Medical Center, Chicago, IL; ‡Clinical Trials Division, Westat, Inc., Rockville, MD; §Maternal-Child and Adolescent HIV Management and Research Center, University of Southern California School of Medicine, Los Angeles, CA; and ¶Center for Population Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD.

Received for publication October 22, 2003; accepted September 13, 2004.

Supported by the Division of AIDS Treatment Research Initiative, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD (contract NO1-AI-15123); Program Support Center, Department of Health and Human Services (contract 282-98-0015, Task Order Number 21); and PO1 HD40539.

Reprints: Jonathan A. Cohn, 4201 St. Antoine 7D, Detroit, MI 48201 (e-mail:

© 2005 Lippincott Williams & Wilkins, Inc.