Department of Obstetrics and Gynecology, Division of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria.
Center for Medical Statistics, Informatics and Intelligent Systems (IMS), Medical University of Vienna, Vienna, Austria.
Birth. 2021 Mar;48(1):139-146. doi: 10.1111/birt.12526. Epub 2021 Jan 18.
This study aimed to evaluate the vaginal microbiota of HIV-positive pregnant women relative to HIV-negative controls, and to compare their risk of vaginal dysbiosis, bacterial vaginosis, and vulvovaginal candidosis (VVC).
This is a nested matched case-control study that analyzed data from women who received pregnancy care at our center from 2003 to 2014. Women routinely underwent screening for asymptomatic vaginal infections using phase microscopy on Gram-stained smears. HIV-positive women were assigned to the case group, and HIV-negative women were assigned to the control group. Cases and controls were matched in a 1:4 ratio. Logistic regression was used to test whether HIV infection was associated with vaginal dysbiosis (Nugent score 4-6), BV (Nugent score 7-10), or VVC.
One hundred and twenty-seven women were assigned to the case group, and 4290 were assigned to the control group (including 508 matched controls). Dysbiosis or BV was found in 29.9% of the cases and 17.6% of the controls. Women in the case group had increased risk of vaginal dysbiosis or BV (odds ratio [OR] 2.09, 95% confidence interval [CI], 1.30-3.32, P = .002). The risk of VVC was also higher in the case group (OR 2.14, 95% CI, 1.22-3.77, P = .008). The incidence of preterm birth did not differ significantly between the groups (cases: 8.7%; controls: 10%, P = .887).
HIV-positive women are at risk of vaginal dysbiosis, BV, and VVC during pregnancy. As imbalances of the vaginal microbiota can lead to preterm birth, screening and treatment of HIV-positive pregnant women are warranted.
本研究旨在评估 HIV 阳性孕妇的阴道微生物群与 HIV 阴性对照者的关系，并比较其阴道生态失调、细菌性阴道病和外阴阴道念珠菌病（VVC）的风险。
这是一项嵌套病例对照研究，分析了 2003 年至 2014 年在我们中心接受妊娠护理的女性的数据。女性常规接受无症状阴道感染筛查，采用革兰氏染色涂片相位显微镜检查。将 HIV 阳性女性分配到病例组，HIV 阴性女性分配到对照组。病例和对照按 1:4 比例匹配。使用逻辑回归检验 HIV 感染是否与阴道生态失调（Nugent 评分 4-6）、BV（Nugent 评分 7-10）或 VVC 相关。
127 名女性被分配到病例组，4290 名女性被分配到对照组（包括 508 名匹配对照者）。病例组中有 29.9%和对照组中有 17.6%的女性存在生态失调或 BV。病例组阴道生态失调或 BV 的风险增加（比值比[OR] 2.09，95%置信区间[CI]，1.30-3.32，P=0.002）。病例组 VVC 的风险也更高（OR 2.14，95%CI，1.22-3.77，P=0.008）。两组早产发生率无显著差异（病例组：8.7%；对照组：10%，P=0.887）。
HIV 阳性孕妇在妊娠期间存在阴道生态失调、BV 和 VVC 的风险。由于阴道微生物群失衡可能导致早产，因此需要对 HIV 阳性孕妇进行筛查和治疗。
