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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*

Sexually Transmitted Diseases: March 2014 - Volume 41 - Issue 3 - p 173–179
doi: 10.1097/OLQ.0000000000000089
Original Study

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.

Trichomonas vaginalis/bacterial vaginosis co-occurrence is common and associated with a synergistic increase in vaginal shedding of HIV-1. Screening and prompt treatment of these conditions among HIV-positive women are important for HIV prevention.

From the *Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA; †Department of Public Health, University of Southern Mississippi, Hattiesburg, MS; Departments of ‡Microbiology, Immunology, and Parasitology and §Internal Medicine, Louisiana State University, New Orleans, LA; ¶Department of Medicine Education Programs, University of Mississippi Medical Center, Jackson, MS; ∥Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; and **Department of Biostatistics, Tulane School of Public Health and Tropical Medicine, New Orleans, LA.

Conflict of interest: None declared.

Presented at the 19th International AIDS Conference: Fastring, D., Amedee, A., Clark, R., Mena, L., Levison, J., Gatski, M., Schmidt, N., Rice, J., Hassig, S., Gustat, J., Xiong, X., Kissinger, P. Vaginal shedding of HIV-1 RNA in the presence of Trichomonas vaginalis and bacterial vaginosis. 19th International AIDS Conference: Abstract No. WEPE065.

Ethics approval of research: Tulane School of Public Health and Tropical Medicine IRB no. 12-326004E secondary analysis. Original studies were approved by Tulane IRB Nos. K0197 and K0231.

Contributors: D.F., P.K., M.G., and J.R. designed the study and conducted statistical and epidemiologic analysis. All authors contributed to either the interpretation of findings or the review of drafts of the manuscript.

Funding: This research was supported by Centers for Disease Control and Prevention Grants RA1-CCR622272 and NIAID 1U19A161972-01, and the Louisiana Board of Regents Grant HEF(2001-6)04.

Correspondence: Patricia Kissinger, Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal St, New Orleans, LA. E-mail:

Received for publication April 4, 2013, and accepted December 5, 2013.

© Copyright 2014 American Sexually Transmitted Diseases Association