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Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition
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Mar 13 2018
Source: AIDS. 32(5):595-604
[PDF-126.53 KB]
Details:
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Alternative Title:AIDS
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Personal Author:
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Description:Objective
To examine BV as an effect modifier for the association between hormonal contraception (HC) and incident HIV infection
Design
Serodiscordant couples enrolled in an open longitudinal cohort in Lusaka, Zambia from 1994–2012. This analysis was restricted to couples with an HIV-positive man enrolled between1994–2002 when a quarterly genital tract examination and HIV testing was performed.
Methods
Multivariate Cox models evaluated the association between contraceptive method and HIV-acquisition, stratified by time-varying BV status.
Results
Among 564 couples contributing 1137.2 couple-years of observation, BV was detected at 15.5% of study visits. 22 of 106 seroconversions occurred during intervals after BV was detected (12 on no method/non-hormonal method (non-HC), 2 on injectables, 8 on oral contraceptive pills, (OCPs)). Unadjusted seroincidence rates per 100-couple-years for non-HC, injectable, and OCP users, respectively, during intervals with BV were 8.3, 20.8 and 31.0 and during intervals without BV were 8.2, 9.7 and 12.3. In the BV-positive model, there was a significant increase in incident HIV among those using injectables (adjusted hazard ratio, aHR 6.55, 95% CI 1.14–37.77) and OCPs (aHR 5.20, 95% CI 1.68–16.06) compared to non-HC. HC did not increase the hazard of HIV acquisition in BV-negative models. These findings persisted in sensitivity analyses when all covariates from the nonstratified model previously published were included, when other genital tract findings were excluded from the model and with the addition of condom-less sex and sperm on wet-prep.
Conclusions
Future research should consider a potential interaction with BV when evaluating the impact of HC on HIV acquisition.
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Pubmed ID:29334545
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Pubmed Central ID:PMC5832628
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