Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

English version České info

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 (I² 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<0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001), respectively.

Conclusions:
This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated.

: Please see later in the article for the Editors' Summary

Vyšlo v časopise: Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis. PLoS Med 8(2): e32767. doi:10.1371/journal.pmed.1000416
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pmed.1000416

Souhrn

Zdroje

1. UNAIDS 2008 Report on the global HIV/AIDS epidemic 2008. UNAIDS/08.25E/JC1510E. Geneva: Joint United Nations Programme on HIV/AIDS

2. MorrisGC

LaceyCJ

2010 Microbicides and HIV prevention: lessons from the past, looking to the future. Curr Opin Infect Dis 23 57 63

3. RamjeeG

GovindenR

MorarNS

MbewuA

2007 South Africa's experience of the closure of the cellulose sulphate microbicide trial. PLoS Med 4 e235 doi:10.1371/journal.pmed.0040235

4. ShattockRJ

MooreJP

2003 Inhibiting sexual transmission of HIV-1 infection. Nature Rev Microbiol 1 25 34

5. Martin HilberA

HullTH

Preston-WhyteE

BagnolB

WacharasinC

2010 A cross cultural study of vaginal practices and sexuality: implications for sexual health. Soc Sci Med 70 392 400

6. HilberAM

ChersichMF

van de WijgertJH

ReesH

TemmermanM

2007 Vaginal practices, microbicides and HIV: what do we need to know? Sex Transm Infect 83 505 508

7. MyerL

KuhnL

SteinZA

WrightTCJr.

Denny L

2005 Intravaginal practices, bacterial vaginosis, and women's susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis 5 786 794

8. McClellandRS

LavreysL

HassanWM

MandaliyaK

Ndinya-AcholaJO

2006 Vaginal washing and increased risk of HIV-1 acquisition among African women: a 10-year prospective study. AIDS 20 269 273

9. MyerL

DennyL

TelerantR

SouzaM

WrightTCJr.

2005 Bacterial vaginosis and susceptibility to HIV infection in South African women: a nested case-control study. J Infect Dis 192 1372 1380

10. AtashiliJ

PooleC

NdumbePM

AdimoraAA

SmithJS

2008 Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies. AIDS 22 1493 1501

11. van de WijgertJH

MorrisonCS

BrownJ

KwokC

Van der PolB

2009 Disentangling contributions of reproductive tract infections to HIV acquisition in African women. Sex Transm Dis 36 357 364

12. Martin HilberA

FrancisSC

ChersichMF

ScottP

RedmondS

2010 Intravaginal practices, vaginal infections and HIV acquisition: systematic review and meta-analysis. PloS One 5 e9119 doi:10.1371/journal.pone.0009119

13. van de WijgertJH

MorrisonCS

CornelissePG

MunjomaM

MoncadaJ

2008 Bacterial vaginosis and vaginal yeast, but not vaginal cleansing, increase HIV-1 acquisition in African women. J Acquir Immune Defic Syndr 48 203 210

14. SimmondsMC

HigginsJP

StewartLA

TierneyJF

ClarkeMJ

2005 Meta-analysis of individual patient data from randomized trials: a review of methods used in practice. Clin Trials 2 209 217

15. PadianNS

van der StratenA

RamjeeG

ChipatoT

de BruynG

2007 Diaphragm and lubricant gel for prevention of HIV acquisition in southern African women: a randomised controlled trial. Lancet 370 251 261

16. NugentRP

KrohnMA

HillierSL

1991 Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 29 297 301

17. IsonCA

HayPE

2002 Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics. Sex Transm Infect 78 413 415

18. AmselR

TottenPA

SpiegelCA

ChenKC

EschenbachD

1983 Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med 74 14 22

19. KumwendaN

HoffmanI

ChirenjeM

KellyC

ColettiA

2006 HIV incidence among women of reproductive age in Malawi and Zimbabwe. Sex Transm Dis 33 646 651

20. MyerL

DennyL

de SouzaM

WrightTCJr.

KuhnL

2006 Distinguishing the temporal association between women's intravaginal practices and risk of human immunodeficiency virus infection: a prospective study of South African women. Am J Epidemiol 163 552 560

21. von ElmE

AltmanDG

EggerM

PocockSJ

GotzschePC

2007 The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4 e296 doi:10.1371/journal.pmed.0040296

22. HigginsJP

ThompsonSG

2002 Quantifying heterogeneity in a meta-analysis. Stat Med 21 1539 1558

23. GreenlandS

1989 Modeling and variable selection in epidemiologic analysis. Am J Public Health 79 340 349

24. BrotmanRM

KlebanoffMA

NanselTR

AndrewsWW

SchwebkeJR

2008 A longitudinal study of vaginal douching and bacterial vaginosis - a marginal structural modeling analysis. Am J Epidemiol 168 186 191

25. McCullaghP

1980 Regression models for ordinal data. J Royal Stat Soc Series B (Methodological) 42 109 142

26. GhysPD

DialloMO

Ettiegne-TraoreV

SattenGA

AnomaCK

2001 Effect of interventions to control sexually transmitted disease on the incidence of HIV infection in female sex workers. AIDS 15 1421 1431

27. HesterRA

KennedySB

2003 Candida infection as a risk factor for HIV transmission. J Womens Health (Larchmt) 12 487 494

28. HiraSK

MangrolaUG

MwaleC

ChintuC

TemboG

1990 Apparent vertical transmission of human immunodeficiency virus type 1 by breast-feeding in Zambia. J Pediatr 117 421 424

29. KapigaSH

SamNE

BangH

NiQ

AoTT

2007 The role of herpes simplex virus type 2 and other genital infections in the acquisition of HIV-1 among high-risk women in northern Tanzania. J Infect Dis 195 1260 1269

30. KleinschmidtI

ReesH

DelanyS

SmithD

DinatN

2007 Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort. Contraception 75 461 467

31. NagotN

OuedraogoA

DeferMC

ValloR

MayaudP

2007 Association between bacterial vaginosis and Herpes simplex virus type-2 infection: implications for HIV acquisition studies. Sex Transm Infect 83 365 368

32. RiednerG

HoffmannO

RusizokaM

MmbandoD

MabokoL

2006 Decline in sexually transmitted infection prevalence and HIV incidence in female barworkers attending prevention and care services in Mbeya Region, Tanzania. AIDS 20 609 615

33. TahaTE

HooverDR

DallabettaGA

KumwendaNI

MtimavalyeLA

1998 Bacterial vaginosis and disturbances of vaginal flora: association with increased acquisition of HIV. AIDS 12 1699 1706

34. van de WijgertJH

MasonPR

GwanzuraL

MbizvoMT

ChirenjeZM

2000 Intravaginal practices, vaginal flora disturbances, and acquisition of sexually transmitted diseases in Zimbabwean women. J Infect Dis 181 587 594

35. MorrisonCS

RichardsonBA

MmiroF

ChipatoT

CelentanoDD

2007 Hormonal contraception and the risk of HIV acquisition. AIDS 21 85 95

36. Delany-MoretlweS

ReesH

2010 Tshireletso study for women's health. Reproductive Health Research Unit (RHRU). Microbicide feasibility study. Protocol Hillbrow, South Africa RHRU, University of Witwatersrand

37. KaulR

KimaniJ

NagelkerkeNJ

FonckK

NgugiEN

2004 Monthly antibiotic chemoprophylaxis and incidence of sexually transmitted infections and HIV-1 infection in Kenyan sex workers: a randomized controlled trial. JAMA 291 2555 2562

38. BosireW

LuchtersS

NelA

MalavaE

MalonzaI

2010 A prospective microbicides preparedness study for estimation of HIV-1 incidence among female sex workers in Mombasa, Kenya. Proceedings of Microbicides 2008 New Delhi, India February 2008 126

39. PettiforA

DelanyS

KleinschmidtI

MillerWC

AtashiliJ

2009 Use of injectable progestin contraception and risk of STI among South African women. Contraception 80 555 560

40. RamjeeG

KapigaS

WeissS

PetersonL

LeburgC

2008 The value of site preparedness studies for future implementation of phase 2/IIb/III HIV prevention trials: experience from the HPTN 055 study. J Acquir Immune Defic Syndr 47 93 100

41. SubramanianL

McGrathN

NdlovuH

GafosM

2008 Family planning methods among women in a vaginal microbicide feasibility study in rural KwaZulu-Natal, South Africa. Afr J Reprod Health 12 45 63

42. VallelyA

HambletonIR

KasindiS

KnightL

FrancisSC

2010 Are women who work in bars, guesthouses and similar facilities a suitable study population for vaginal microbicide trials in Africa? PloS One 5 e10661 doi:10.1371/journal.pone.0010661

43. Watson-JonesD

WeissHA

RusizokaM

ChangaluchaJ

BaisleyK

2008 Effect of herpes simplex suppression on incidence of HIV among women in Tanzania. N Engl J Med 358 1560 1571

44. van de WijgertJ

MorrisonC

SalataR

PadianN

2006 Is vaginal washing associated with increased risk of HIV-1 acquisition? AIDS 20 1347 1348

45. BrotmanRM

RavelJ

ConeRA

ZenilmanJM

2010 Rapid fluctuation of the vaginal microbiota measured by Gram stain analysis. Sex Transm Infect 86 297 302

46. FletcherPS

HarmanSJ

BootheAR

DoncelGF

ShattockRJ

2008 Preclinical evaluation of lime juice as a topical microbicide candidate. Retrovirol 5 3

47. AllenCF

DesmondN

ChiduoB

MedardL

LeesSS

2010 Intravaginal and menstrual practices among women working in food and recreational facilities in Mwanza, Tanzania: implications for microbicide trials. AIDS Behav 14 1169 1181

48. Abdool KarimQ

Abdool KarimSS

FrohlichJA

GroblerAC

BaxterC

2010 Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science 329 1168 1174

49. van der StratenA

ChengH

ChidanyikaA

deBG

PadianN

2010 Vaginal practices and associations with barrier methods and gel use among Sub-Saharan African women enrolled in an HIV prevention trial. AIDS Behav 14 590 599

50. GrimleyDM

OhMK

DesmondRA

HookEWIII

VermundSH

2005 An intervention to reduce vaginal douching among adolescent and young adult women: a randomized, controlled trial. Sex Transm Dis 32 752 758