Taha T E, Hoover D R, Dallabetta G A, Kumwenda N I, Mtimavalye L A, Yang L P, Liomba G N, Broadhead R L, Chiphangwi J D, Miotti P G
Department of Epidemiology, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA.
AIDS. 1998 Sep 10;12(13):1699-706. doi: 10.1097/00002030-199813000-00019.
Cross-sectional studies suggest an association between bacterial vaginosis (BV) and HIV-1 infection. However, an assessment of a temporal effect was not possible.
To determine the association of BV and other disturbances of vaginal flora with HIV seroconversion among pregnant and postnatal women in Malawi, Africa.
Longitudinal follow-up of pregnant and postpartum women.
Women attending their first antenatal care visit were screened for HIV after counselling and obtaining informed consent. HIV-seronegative women were enrolled and followed during pregnancy and after delivery. These women were again tested for HIV at delivery and at 6-monthly visits postnatally. Clinical examinations and collection of laboratory specimens (for BV and sexually transmitted diseases) were conducted at screening and at the postnatal 6-monthly visits. The diagnosis of BV was based on clinical criteria. Associations of BV and other risk factors with HIV seroconversion, were examined using contingency tables and multiple logistic regression analyses on antenatal data, and Kaplan-Meier proportional hazards analyses on postnatal data.
Among 1196 HIV-seronegative women who were followed antenatally for a median of 3.4 months, 27 women seroconverted by time of delivery. Postnatally, 97 seroconversions occurred among 1169 seronegative women who were followed for a median of 2.5 years. Bacterial vaginosis was significantly associated with antenatal HIV seroconversion (adjusted odds ratio = 3.7) and postnatal HIV seroconversion (adjusted rate ratio = 2.3). There was a significant trend of increased risk of HIV seroconversion with increasing severity of vaginal disturbance among both antenatal and postnatal women. The approximate attributable risk of BV alone was 23% for antenatal HIV seroconversions and 14% for postnatal seroconversions.
This prospective study suggests that progressively greater disturbances of vaginal flora, increase HIV acquisition during pregnancy and postnatally. The screening and treating of women with BV could restore normal flora and reduce their susceptibility to HIV.
横断面研究表明细菌性阴道病（BV）与HIV-1感染之间存在关联。然而，无法评估时间效应。
确定非洲马拉维孕妇和产后妇女中BV及其他阴道菌群紊乱与HIV血清转化之间的关联。
对孕妇和产后妇女进行纵向随访。
首次产前检查的妇女在接受咨询并获得知情同意后进行HIV筛查。HIV血清学阴性的妇女被纳入研究，并在孕期和产后进行随访。这些妇女在分娩时和产后每6个月进行一次HIV检测。在筛查时和产后每6个月进行临床检查并采集实验室标本（用于检测BV和性传播疾病）。BV的诊断基于临床标准。使用列联表和对产前数据进行多元逻辑回归分析，以及对产后数据进行Kaplan-Meier比例风险分析，研究BV和其他危险因素与HIV血清转化之间的关联。
在1196名产前接受随访的HIV血清学阴性妇女中，中位随访时间为3.4个月，有27名妇女在分娩时发生血清转化。产后，在1169名血清学阴性妇女中，中位随访时间为2.5年，发生了97次血清转化。细菌性阴道病与产前HIV血清转化（调整优势比=3.7）和产后HIV血清转化（调整率比=2.3）显著相关。产前和产后妇女中，随着阴道紊乱严重程度的增加，HIV血清转化风险呈显著上升趋势。仅BV导致的产前HIV血清转化的归因风险约为23%，产后血清转化的归因风险约为14%。
这项前瞻性研究表明，阴道菌群紊乱程度逐渐加重会增加孕期和产后感染HIV的几率。对BV患者进行筛查和治疗可以恢复正常菌群，降低她们感染HIV的易感性。
