Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women
Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women
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DOI：
10.1097/qai.0b013e3181743936
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发表时间：
2008-06-01
影响因子：
3.6
通讯作者：
Padian, Nancy S.
中科院分区：
文献类型：
--
作者：
van de Wijgert, Danneke H. H. M.;Morrison, Charles S.;Padian, Nancy S.
目的：评价细菌性阴道病（BV）、阴道酵母菌、阴道操作（清洁和干燥/收紧）、粘膜炎症和HIV感染之间的相互关系。方法：进行了一项多中心、前瞻性、观察性队列研究，纳入了4531名年龄在18至35岁之间、在津巴布韦和乌干达的计划生育诊所就诊的艾滋病毒阴性妇女。研究人员对参与者进行了艾滋病毒和生殖道感染检测，并在15至24个月的时间里，每3个月对他们进行一次阴道检查。革兰氏染色纽金特评分法测定BV，湿贴法测定阴道酵母菌，革兰氏染色法测定粘膜炎症。结果：在津巴布韦和乌干达，艾滋病毒感染率分别为每100名妇女随访年4.12和1.53例（共213例事件感染）。感染细菌性阴道炎或阴道酵母菌的妇女更有可能感染艾滋病毒，特别是如果这种情况与新的艾滋病毒感染发生在同一次就诊以及之前的就诊（细菌性阴道炎和酵母菌的风险比[HR] = 2.50, 95%可信区间[CI]: 1.68至3.72,HR = 2.97, 95% CI: 1.67至5.28）。这些关系似乎不是由粘膜炎症介导的。阴道干燥/收紧在单变量模型中与HIV感染相关（HR = 1.49, 95% CI: 1.03至2.15），但在多变量模型中与HIV感染无关。阴道清洁与HIV感染无关。结论：细菌性阴道炎和酵母菌可能比以前认为的对HIV流行的贡献更大。
Objective: To evaluate interrelationships between bacterial vaginosis (BV), vaginal yeast, vaginal practices (cleansing and drying/ tightening), mucosal inflammation, and HIV acquisition.Methods: A multicenter, prospective, observational cohort study was conducted, enrolling 4531 HIV-negative women aged 18 to 35 years attending family planning clinics in Zimbabwe and Uganda. Participants were tested for HIV and reproductive tract infections and were interviewed about vaginal practices every 3 months for 15 to 24 months. BV was measured by Gram stain Nugent scoring, vaginal yeast by wet mount, and mucosal inflammation by white blood cells on Gram stain.Results: HIV incidence was 4.12 and 1.53 per 100 woman-years of follow-up in Zimbabwe and Uganda, respectively (a total of 213 incident infections). Women with BV or vaginal yeast were more likely to acquire HIV especially if the condition was present at the same visit as the new HIV infection and the visit preceding it (hazard ratio [HR] = 2.50, 95% confidence interval [CI]: 1.68 to 3.72 and HR = 2.97, 95% CI: 1.67 to 5.28 for BV and yeast, respectively). These relationships did not seem to be mediated by mucosal inflammation. Vaginal drying/tightening was associated with HIV acquisition in univariate (HR = 1.49, 95% CI: 1.03 to 2.15) but not multivariate models. Vaginal cleansing was not associated with HIV acquisition.Conclusions: BV and yeast may contribute more to the HIV epidemic than previously thought.