Bacterial vaginosis and the risk of trichomonas vaginalis acquisition among HIV-1-negative women.
Bacterial vaginosis and the risk of trichomonas vaginalis acquisition among HIV-1-negative women.
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DOI：
10.1097/olq.0000000000000075
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发表时间：
2014-02
影响因子：
3.1
通讯作者：
Abdool Karim SS
中科院分区：
文献类型：
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作者：
Balkus JE;Richardson BA;Rabe LK;Taha TE;Mgodi N;Kasaro MP;Ramjee G;Hoffman IF;Abdool Karim SS
阴道微生物群可能在调节对包括阴道毛滴虫(TV)在内的性传播感染的易感性方面发挥作用。分析了参加艾滋病毒预防试验网络协议035的HIV-1血清阴性妇女的数据。在长达30个月的季度访问中，参与者完成结构化访谈，并收集样本进行生殖道感染测试。生理盐水显微镜下检测TV。Gram染色采用Nugent评分(BV=7~10；中度=4~6；正常=0~3[参照组])。使用COX比例风险模型对研究地点进行分层，以评估先前每季度就诊时的Nugent评分类别与获得电视节目之间的关系。在这项二次分析中，来自马拉维、南非、美国、赞比亚和津巴布韦的2920名参与者提供了16,259次后续访问。检出BV 5680人次(35%)，电视400人次(2.5%)。调整了年龄、婚姻状况、激素避孕措施的使用、最近一周的无保护性行为和基线电视，中位Nugent评分和上次就诊时的BV与TV的风险增加相关(中间评分：调整后的危险比[AHR]=1.73，95%可信区间[CI]1.21~2.19；BV：AHR=2.40，95%CI 1.92~3.00)。剔除211名基线有电视的参与者的敏感性分析与来自全部研究人群的敏感性分析相似(中间得分：AHR=1.54，95%可信区间1.10-2.14；BV：AHR=2.23，95%可信区间1.75-2.84)具有Nugent评分>；3的女性患电视的风险增加。如果这种关系是因果关系，改善阴道微生物区系的干预措施可能有助于减少电视发病率。
The vaginal microbiota may play a role in mediating susceptibility to sexually transmitted infections, including Trichomonas vaginalis (TV). Data were analyzed from HIV-1 seronegative women participating in HIV Prevention Trials Network Protocol 035. At quarterly visits for up to 30 months, participants completed structured interviews and specimens were collected for genital tract infection testing. TV was detected by saline microscopy. BV was characterized by Gram stain using the Nugent score (BV=7-10; intermediate=4-6; normal=0-3 [reference group]). Cox proportional hazards models stratified by study site were used to assess the association between Nugent score category at the prior quarterly visit and TV acquisition. In this secondary analysis, 2,920 participants from Malawi, South Africa, USA, Zambia and Zimbabwe contributed 16,259 follow-up visits. BV was detected at 5,680 (35%) visits and TV was detected at 400 (2.5%) visits. Adjusting for age, marital status, hormonal contraceptive use, unprotected sex in the last week and TV at baseline, intermediate Nugent score and BV at the prior visit were associated with an increased risk of TV (intermediate score: adjusted hazard ratio [aHR]=1.73, 95% confidence interval [CI] 1.21-2.19; BV: aHR=2.40, 95% CI 1.92-3.00). Sensitivity analyses excluding 211 participants with TV at baseline were similar to those from the full study population (intermediate score: aHR=1.54, 95% CI 1.10-2.14; BV: aHR=2.23, 95% CI 1.75-2.84) Women with a Nugent score >3 were at an increased risk of acquiring TV. If this relationship is causal, interventions that improve the vaginal microbiota could contribute to reductions in TV incidence.