阴道毛滴虫和细菌性阴道病的共同发生与 HIV-1 RNA 的阴道脱落。

Co-occurrence of Trichomonas vaginalis and bacterial vaginosis and vaginal shedding of HIV-1 RNA.

机构信息

From the *Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, LA; †Department of Public Health, University of Southern Mississippi, Hattiesburg, MS; Departments of ‡Microbiology, Immunology, and Parasitology and §Internal Medicine, Louisiana State University, New Orleans, LA; ¶Department of Medicine Education Programs, University of Mississippi Medical Center, Jackson, MS; ∥Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX; and **Department of Biostatistics, Tulane School of Public Health and Tropical Medicine, New Orleans, LA.

出版信息

Sex Transm Dis. 2014 Mar;41(3):173-9. doi: 10.1097/OLQ.0000000000000089.

DOI:10.1097/OLQ.0000000000000089

PMID:24521723

Abstract

BACKGROUND

Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.

METHODS

HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.

RESULTS

In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.

CONCLUSIONS

T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.

摘要

背景

阴道毛滴虫（TV）和细菌性阴道病（BV）均与 HIV 阳性女性阴道病毒脱落的风险增加独立相关。由于这两种情况通常同时发生，因此进行了这项研究，以检查 TV/BV 同时发生与 HIV-1 RNA 阴道脱落之间的关联。

方法

在 3 个美国城市的门诊 HIV 诊所就诊的 HIV 阳性女性接受了临床检查；接受了 TV、BV、淋病奈瑟菌、沙眼衣原体和外阴阴道念珠菌病的筛查；并完成了行为调查。与阴道 HIV-1 RNA 未检出（<50 拷贝/mL）的女性相比，阴道病毒脱落（≥50 拷贝/mL）的女性被确定为 TV 阳性和 BV 阳性或同时存在 TV/BV 的女性，与未发生这些情况的女性相比，阴道脱落的几率更高。

结果

在这个 373 名 HIV 阳性女性的样本中，43.1%（n = 161）同时存在 TV/BV，33.2%（n = 124）阴道 HIV-1 RNA 脱落。单独存在 TV 或 BV 以及同时存在 TV/BV 时，阴道 HIV 脱落的几率分别为 4.07（95%置信区间 [CI]，1.78-9.37）、5.65（95% CI，2.64-12.01）和 18.63（95% CI，6.71-51.72），与未诊断为 TV 或 BV 的女性相比，调整年龄、抗逆转录病毒治疗状况和血浆病毒载量后。