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，当阴道内健康的乳酸杆菌浓度下降并被其他（主要是厌氧）细菌所取代时发生。细菌性阴道炎是全世界育龄妇女最常见的阴道感染。感染细菌性阴道炎的孕妇发生自然流产、早产、绒毛膜羊膜炎和其他有害的产科和妇科后果的风险增加。根据最近对3万多名妇女的荟萃分析，流行的细菌性阴阳炎与感染人类免疫缺陷病毒（HIV）的风险增加60%有关。然而，这种复杂疾病的病因尚不清楚。我们假设低维生素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，又可以调节免疫反应。在美国，细菌性阴道炎的最大危险因素是非白人种族，非白人女性也更有可能缺乏或缺乏维生素D。事实上，最近的两项横断面分析报告称，维生素D不足与非裔美国孕妇中普遍存在的BV有关；第三份出版物发现维生素D和BV之间存在同样的联系，在全国具有代表性的孕妇人群中，包括所有种族/民族类别。这些数据表明，种族和细菌性肠胃炎之间的一致关联（尽管对其他细菌性肠胃炎危险因素进行了调整）可能是由维生素D介导的。在资源有限的环境中，关于维生素D水平的数据很少，包括撒哈拉以南非洲，那里细菌性肠胃炎患病率很高，细菌性肠胃炎相关发病率很高。使用来自近600名津巴布韦妇女的储存血清样本，这些妇女之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患病率之间的关系；b) BV发病率；c) BV持久性。在对50名BV阳性和50名BV阴性妇女储存的宫颈和血清样本进行探索性分析中，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的免疫学机制。维生素D安全、便宜，对健康有很多好处。如果维生素D也与细菌性阴道炎有关，那么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. PUBLIC HEALTH RELEVANCE: Bacterial vaginosis is the most common vaginal infection in women of reproductive age worldwide. We hypothesize that low vitamin D levels contribute to increased risk of bacterial vaginosis. This study will test stored, prospectively-collected biological samples and use existing demographic, behavioral and clinical information from almost 600 Zimbabwean women to assess the influence of vitamin D on the prevalence, incidence and persistence of bacterial vaginosis.