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Sexually Transmitted Diseases:
doi: 10.1097/OLQ.0000000000000089
Original Study

Co-occurrence of Trichomonas vaginalis and Bacterial Vaginosis and Vaginal Shedding of HIV-1 RNA

Fastring, Danielle R. PhD, MPH*†; Amedee, Angela PhD; Gatski, Megan MSN, PhD*; Clark, Rebecca A. MD, PhD§; Mena, Leandro A. MD, MPH; Levison, Judy MD, MPH; Schmidt, Norine MPH*; Rice, Janet PhD**; Gustat, Jeanette PhD*; Kissinger, Patricia PhD*

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Abstract

Background: Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.

Methods: HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.

Results: In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78–9.37), 5.65 (95% CI, 2.64–12.01), and 18.63 (95% CI, 6.71–51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.

Conclusions: T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.

© Copyright 2014 American Sexually Transmitted Diseases Association

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