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Bacterial Vaginosis and Vaginal Yeast, But Not Vaginal Cleansing, Increase HIV-1 Acquisition in African Women

van de Wijgert, Janneke H H M PhD, MPH*; Morrison, Charles S PhD, MPH; Cornelisse, Peter G A MSc; Munjoma, Marshall DMLS, MPH§; Moncada, Jeanne MT; Awio, Peter DMLS; Wang, Jing MA, MSc; Van der Pol, Barbara PhD, MPH#; Chipato, Tsungai MB ChB, FRCOG§; Salata, Robert A MD**; Padian, Nancy S PhD, MPH

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1st, 2008 - Volume 48 - Issue 2 - p 203-210
doi: 10.1097/QAI.0b013e3181743936
Epidemiology and Social Science

Objective: To evaluate interrelationships between bacterial vaginosis (BV), vaginal yeast, vaginal practices (cleansing and drying/tightening), mucosal inflammation, and HIV acquisition.

Methods: A multicenter, prospective, observational cohort study was conducted, enrolling 4531 HIV-negative women aged 18 to 35 years attending family planning clinics in Zimbabwe and Uganda. Participants were tested for HIV and reproductive tract infections and were interviewed about vaginal practices every 3 months for 15 to 24 months. BV was measured by Gram stain Nugent scoring, vaginal yeast by wet mount, and mucosal inflammation by white blood cells on Gram stain.

Results: HIV incidence was 4.12 and 1.53 per 100 woman-years of follow-up in Zimbabwe and Uganda, respectively (a total of 213 incident infections). Women with BV or vaginal yeast were more likely to acquire HIV, especially if the condition was present at the same visit as the new HIV infection and the visit preceding it (hazard ratio [HR] = 2.50, 95% confidence interval [CI]: 1.68 to 3.72 and HR = 2.97, 95% CI: 1.67 to 5.28 for BV and yeast, respectively). These relationships did not seem to be mediated by mucosal inflammation. Vaginal drying/tightening was associated with HIV acquisition in univariate (HR = 1.49, 95% CI: 1.03 to 2.15) but not multivariate models. Vaginal cleansing was not associated with HIV acquisition.

Conclusions: BV and yeast may contribute more to the HIV epidemic than previously thought.

From the *Academic Medical Center, Center for Poverty-Related Communicable Diseases, Amsterdam, The Netherlands; †Family Health International (FHI), Research Triangle Park, NC; ‡Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA; §University of Zimbabwe, Harare, Zimbabwe; ∥University of California at San Francisco, San Francisco, CA; ¶Joint Clinical Research Center, Kampala, Uganda; #Indiana University School of Medicine, Indianapolis, IN; and **Case Western University, Cleveland, OH.

P. G. A. Cornelisse is currently affiliated with Merck Serono International S.A., Geneva, Switzerland.

Received for publication October 10, 2007; accepted March 14, 2008.

None of the authors have a commercial or other association that might pose a conflict of interest.

Financial support for this study provided by the US National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, through a contract with FHI (contract N01-HD-0-3310).

Preliminary data from this study were presented at the 16th Meeting of the Society for Sexually Transmitted Disease Research, Amsterdam, The Netherlands, July 10-13, 2005, and the 15th International AIDS Conference, Bangkok, Thailand, July 11-16, 2004.

The content of this publication does not necessarily reflect the views and policies of the US Department of Health and Human Services or FHI, nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Correspondence to: Janneke van de Wijgert, PhD, MPH, Academic Medical Center, Center for Poverty-Related Communicable Diseases, Meibergdreef 9 T0-120, 1105 AZ Amsterdam, The Netherlands (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.