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Mycoplasma genitalium infection among HIV-infected pregnant African women and implications for mother-to-child transmission of HIV

Roxby, Alison C.a,b,c; Yuhas, Kristab,h; Farquhar, Careya,b,c; Bosire, Rosef; Mbori-Ngacha, Dorothyg; Richardson, Barbra A.b,e,h; Totten, Patricia A.a,b; John-Stewart, Gracea,b,c,d

doi: 10.1097/QAD.0000000000002335
Epidemiology and Social
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Objective: Many sexually transmitted infections increase risk of mother-to-child transmission (MTCT) of HIV, but the effect of Mycoplasma genitalium is not known. We hypothesized that M. genitalium infection would be common among HIV-infected pregnant women and could be associated with in-utero and intrapartum MTCT.

Design: Observational case–cohort study.

Methods: The current study used specimens from a Kenyan perinatal MTCT cohort (1999–2005) involving HIV-infected women and their infants, who received short-course zidovudine for prevention of MTCT. Vaginal swabs collected at 32 weeks gestation were tested for M. genitalium using a transcription-mediated amplification assay. Infant perinatal HIV infection was determined at birth and 4 weeks of age by DNA PCR. Using a case–cohort design, a random sample was generated with 3 : 1 control : case ratio; prevalence and correlates of M. genitalium were assessed with chi-squared and t tests; predictors of infant outcomes were analyzed using logistic regression.

Results: Among 220 HIV-infected pregnant women evaluated, 47 women (21.4%) had M. genitalium. Antenatal M. genitalium infection was associated with higher HIV RNA in plasma (5.0 vs. 4.6 log10 copies/ml in M. genitalium-positive vs. M. genitalium-negative women, P = 0.02) at 32 weeks. Women with M. genitalium were less likely to report prior sexually transmitted infections and genital ulcers (both P = 0.05). There was no association found between exposure to M. genitalium and perinatal MTCT (odds ratio = 0.72, 95% confidence interval 0.35, 1.51, P = 0.39).

Conclusion: Vaginal M. genitalium infection was frequently detected among Kenyan HIV-infected pregnant women and was associated with higher plasma HIV levels, but was not associated with perinatal transmission of HIV.

aDepartment of Medicine

bDepartment of Global Health

cDepartment of Epidemiology

dDepartment of Pediatrics

eDepartment of Biostatistics, University of Washington, Seattle, Washington, USA

fCentre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya

gUNICEF, New York, New York

hVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.

Correspondence to Alison C. Roxby, MD, MSc, Department of Medicine, University of Washington, 325 9th Ave., Campus Box 359909, Seattle, WA 98104, USA. Tel: +1 206 543 4278; fax: +1 206 543 4818; e-mail: aroxby@uw.edu

Received 10 April, 2019

Revised 20 June, 2019

Accepted 27 June, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.