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Taha Taha E.; Gray, Ronald H.; Kumwenda, Newton I.; Hoover, Donald R.; Mtimavalye, Laban A. R.; Liomba, George N.; Chiphangwi, John D.; Dallabetta, Gina A.; Miotti, Paolo G.
Journal of Acquired Immune Deficiency Syndromes & Human Retrovirology: January 1st, 1999

Summary:Disturbances of vaginal flora are common among women of reproductive age. In areas of sub-Saharan Africa where the prevalence of HIV is high, the frequency of bacterial vaginosis (BV) is also high. In this study, we assessed the association of BV and other disturbances of vaginal flora with prevalent HIV infection in two crosssectional studies among pregnant women in urban Malawi. The prevalence of HIV-1 was 23% in 1990 and 30% in 1993. Overall, 30% of the women had BV, 59% had mild or moderate disturbance of vaginal flora, and only 11% had normal vaginal flora. Increasing prevalence of HIV was significantly associated with increasing severity of disturbance of vaginal flora (p < .00001, χ2 trend test). This trend of increased prevalence persisted after controlling for concurrent sexually transmitted diseases (STDs), sexual activity, and socioeconomic factors. After multivariate adjustment for potential confounders, the odds ratio for the association of BV with prevalent HIV infection was 3.0 (95% confidence interval [CI], 2.4-3.8), that of moderate vaginal disturbance with HIV infection was 2.2 (95% CI, 1.7-2.8), and that of mild vaginal disturbance with HIV infection was 1.6 (95% CI, 1.3-2.1). Among women with BV, HIV infection was higher among younger women than older, implying more recent infection. Although these studies were cross-sectional, our data suggest that BV could be associated with increased susceptibility to HIV infection.

Address correspondence and reprint requests to Taha E. Taha, Infectious Diseases Program, Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Room E6011, 615 North Wolfe Street, Baltimore, MD 21205, U.S.A.; email:

Current affiliation for Paolo G. Miotti is Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes for Health, Bethesda, Maryland, U.S.A.

Manuscript received May 5, 1998; accepted September 11, 1998.

© 1999 Lippincott Williams & Wilkins, Inc.