Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis
Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis
复制标题
DOI：
10.1371/journal.pmed.1000416
复制
发表时间：
2011-02-01
期刊：
影响因子：
15.8
通讯作者：
Hilber, Adriane Martin
中科院分区：
文献类型：
--
作者：
Low, Nicola;Chersich, Matthew F.;Hilber, Adriane Martin
背景资料：查明增加妇女感染艾滋病毒风险的可变因素，是制定由妇女发起的有效预防干预措施的一个关键步骤。本研究的主要目的是汇集来自前瞻性纵向研究的个体参与者数据，以调查撒哈拉以南非洲妇女阴道内实践与获得艾滋病毒感染之间的关联。次要目标是调查阴道内的做法和破坏阴道植物群之间的关联;和破坏阴道植物群和HIV acquisition.Methods和结果：我们进行了一项荟萃分析的个人参与者的数据，从13个前瞻性队列研究，涉及14,874名妇女，其中791人获得HIV感染在21,218妇女年的后续行动。使用随机效应荟萃分析汇总数据。在所有分析中，研究间异质性水平均较低（I-2值0.0%-16.1%）。阴道内使用布或纸（合并校正风险比[aHR] 1.47，95%置信区间[CI] 1.18-1.83），插入产品以干燥或收紧阴道（aHR 1.31，95% CI 1.00-1.71），用肥皂进行阴道内清洁（aHR 1.24，95% CI 1.01-1.53）在控制了过去3个月的年龄、婚姻状况和性伴侣数量后，仍然与HIV感染相关。在基线时阴道植物群正常的女性中，用肥皂进行阴道内清洁也与中间阴道植物群和细菌性阴道病的发生相关（合并校正比值比[OR] 1.24，95% CI 1.04-1.47）。布或纸的使用与阴道植物群破坏的发展无关。在多变量模型中，当基线测量时，中间阴道植物群和细菌性阴道病均与HIV感染相关（aHR 1.54和1.69，p
Background: Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition.Methods and Findings: We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I-2 values 0.0%-16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p