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Modeling the Impact of Trichomonas vaginalis Infection on HIV Transmission in HIV-Infected Individuals in Medical Care

Quinlivan, Evelyn Byrd MD*,†,‡; Patel, Shilpa N. MPH*; Grodensky, Catherine A. MPH*; Golin, Carol E. MD‡,¶,‖; Tien, Hsiao-Chuan PhD; Hobbs, Marcia M. PhD*,†,‡,**

doi: 10.1097/OLQ.0b013e3182593839
Original Study

Background: To assess factors associated with having a Trichomonas vaginalis (TV) infection among persons receiving care for human immunodeficiency virus (HIV) and estimate the number of transmitted HIV infections attributable to TV.

Methods: HIV clinic patients were recruited from 2 secondary prevention studies, screened by urine nucleic-acid amplification tests for sexually transmitted infections, and interviewed about risk factors (baseline, 6, and 12 months). We conducted mathematical modeling of the results to estimate the number of transmitted HIV infections attributable to TV among a cohort of HIV-infected patients receiving medical care in North Carolina.

Results: TV was prevalent in 7.4%, and incident in 2% to 3% of subjects at follow-up. Individuals with HIV RNA <400 copies/mL (odds ratio, 0.32; 95% CI: 0.14–0.73) and at least 13 years of education (odds ratio, 0.24; 95% CI: 0.08–0.70) were less likely to have TV. Mathematical modeling predicted that 0.062 HIV transmission events occur per 100 HIV-infected women in the absence of TV infection and 0.076 HIV infections per 100 HIV- and TV-infected women (estimate range: 0.070–0.079), indicating that 23% of the HIV transmission events from HIV-infected women may be attributable to TV infection when 22% of women are coinfected with TV.

Conclusions: The data suggest the need for improved diagnosis of TV infection and suggest that HIV-infected women in medical care may be appropriate targets for enhanced testing and treatment.

From the *Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC; Center for Infectious Diseases, University of North Carolina, Chapel Hill, NC; Center for AIDS Research, Chapel Hill, NC; Department of Health Behavior and Health Education, University of North Carolina, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC; and **The Southeastern Sexually Transmitted Infections Cooperative Research Center, University of North Carolina, Chapel Hill, NC

The authors thank Myron S. Cohen, MD, for his guidance and support, Kimberly Rich for conducting the STI testing, Kathy Ramsey for data management, and the UNC HIV Cohort Database team, especially Brant Stalzer and Sonia Napravnik for assistance with clinical data retrieval and helpful discussions. The authors also acknowledge the clinic staff, providers, and patients for their invaluable contributions to this research.

Current Addresses: Shilpa Patel: Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA. H-C. Tien: Frank Port Graham Child Development Institute, University of North Carolina-Chapel Hill, Chapel Hill, NC.

This study was conducted with the approval of the University of North Carolina—Chapel Hill Institutional Review Board.

Conflicts of interest and sources of funding: This research was supported by a contract or grant from the Centers for Disease Control and Prevention (200–2003–02721), HRSA's Special Projects of National Significance program (HA01289–02), the Clinical and Translational Science Award program of the Division of Research Resources, National Institutes of Health (UL1RR025747), the NC Sexually Transmitted Infections and Topical Microbicides Cooperative Research Center (U19-A131496) and the UNC Centers for AIDS Research (P30-AI50410). The other authors have nothing to declare.

Correspondence: E. Byrd Quinlivan, MD, 130 Mason Farm Road, UNC-CH, Campus Box 7030, Chapel Hill, NC 27599–7030. E-mail:

Received for publication September 11, 2011, and accepted April 5, 2011.

© Copyright 2012 American Sexually Transmitted Diseases Association