Vitamin D and the prevalence, incidence, and persistence of bacterial vaginosis

描述（由申请人提供）：细菌性阴道病（BV）是一种阴道疾病，当阴道中健康的乳酸杆菌属物种的浓度下降并被其他（主要是厌氧）细菌物种取代时发生。BV是世界范围内育龄妇女最常见的阴道感染。BV孕妇发生自然流产、早产、早产、绒毛膜炎和其他有害妇产科结局的风险增加。根据最近对30，000多名妇女的荟萃分析，流行的BV与获得人类免疫缺陷病毒（HIV）的风险增加60%相关。然而，这种复杂疾病的病因尚不清楚。我们推测，低维生素D水平有助于BV的发病机制。维生素D对免疫功能至关重要，既可以刺激与病原体消除相关的机制，也可以调节免疫反应。在美国，BV的最大风险因素是非白人种族，非白人女性也更有可能维生素D水平不足或缺乏。事实上，最近的两项横断面分析报告称，维生素D不足与非洲裔美国孕妇中的BV流行有关;第三篇出版物在全国代表性孕妇人群（包括所有种族/民族分类）中发现了维生素D与BV之间的相同关联。这些数据表明，种族和BV之间的一致关联（尽管调整了其他BV风险因素）可能是由维生素D介导的。在资源有限的环境中，包括撒哈拉以南非洲，关于维生素D水平的数据很少，那里的BV患病率很高，BV相关的发病率很高。使用来自近600名津巴布韦妇女的储存血清样本，这些妇女以前参加了前瞻性、观察性“激素避孕和艾滋病毒感染风险”（HC-HIV）研究，我们建议测量血清维生素D水平与a）BV患病率; B）BV发病率;和c）BV持续性之间的关系。在一项探索性分析中，使用来自50名BV阳性和50名BV阴性妇女亚组的储存宫颈和血清样本，我们还将评估BV相关宫颈免疫炎症介质和维生素D相关血清免疫炎症介质之间的相关性，以阐明维生素D可能影响BV的可能免疫机制。维生素D是安全的，便宜的，有许多健康益处。如果维生素D也与BV有关，补充这种必需维生素可能对全世界妇女的生殖健康产生重大影响。

DESCRIPTION (provided by applicant): Bacterial vaginosis (BV) is a vaginal condition that develops when the concentration of healthy Lactobacillus species in the vagina declines and is replaced by other (largely anaerobic) bacterial species. BV is the most common vaginal infection worldwide in women of reproductive age. Pregnant women with BV have increased risks of spontaneous abortion, preterm labor, preterm birth, chorioamnionitis and other detrimental obstetric and gynecologic outcomes. According to a recent meta-analysis of more than 30,000 women, prevalent BV was associated with a 60% increased risk of acquisition of human immunodeficiency virus (HIV). However, the etiology of this complex condition is not clear. We hypothesize that low vitamin D levels contribute to BV pathogenesis. Vitamin D is essential to immune function, serving both to stimulate mechanisms associated with pathogen elimination and to regulate immune response. In the United States (US), the strongest risk factor for BV is non-white race, and non-white women are also much more likely to have insufficient or deficient vitamin D levels. Indeed, two recent cross-sectional analyses report that vitamin D insufficiency is associated with prevalent BV in pregnant African-American women; a third publication found the same association between vitamin D and BV in a nationally-representative population of pregnant women including all racial/ethnic categorizations. These data suggest that the consistent association between race and BV (despite adjustment for other BV risk factors) may be mediated by vitamin D. Little data exist on vitamin D levels in resource-limited settings, including sub-Saharan Africa where BV prevalence is high and BV- associated morbidities are substantial. Using stored serum samples from nearly 600 Zimbabwean women who previously participated in the prospective, observational "Hormonal Contraception and Risk of HIV Acquisition" (HC-HIV) study, we propose to measure the association between serum vitamin D levels and a) BV prevalence; b) BV incidence; and c) BV persistence. In an exploratory analysis using stored cervical and serum samples from a subgroup of 50 BV-positive and 50 BV-negative women, we will also evaluate correlations between BV-associated cervical immunoinflammatory mediators and vitamin D-associated serum immunoinflammatory mediators to elucidate the possible immunological mechanisms through which vitamin D may affect BV. Vitamin D is safe, inexpensive and has many health benefits. If vitamin D is also associated with BV, supplementation with this essential vitamin may have substantial impact on women's reproductive health worldwide.