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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