Bacterial vaginosis modifies the association between hormonal contraception and HIV acquisition

Details

• Alternative Title:
  AIDS
• Personal Author:
  HADDAD, Lisa B. ; WALL, Kristin M ; KILEMBE, William ; VWAILIKA, Bellington ; KHU, Naw Htee ; BRILL, Ilene ; CHOMBA, Elwyn ; TICHACEK, Amanda ; ALLEN, Susan
• 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.
  
  
• Subjects:
  Adult Contraception Female HIV Infections Humans Incidence Longitudinal Studies Male Risk Assessment Vaginosis, Bacterial Young Adult Zambia

  More +
• Keywords:
  AIDS Bacterial Vaginosis HIV Hormonal Contraception Injectable Contraceptives Oral Contraceptives Vaginal Microbiota
• Source:
  AIDS. 32(5):595-604
• Pubmed ID:
  29334545
• Pubmed Central ID:
  PMC5832628
• Document Type:
  Journal Article
• Funding:
  P30 AI050409/AI/NIAID NIH HHSUnited States/ ; U2G GH001443/GH/CGH CDC HHSUnited States/ ; R01 HD040125/HD/NICHD NIH HHSUnited States/ ; R01 AI051231/AI/NIAID NIH HHSUnited States/ ; R01 AI023980/AI/NIAID NIH HHSUnited States/ ; R37 AI051231/AI/NIAID NIH HHSUnited States/ ; R01 AI064060/AI/NIAID NIH HHSUnited States/ ; U2G PS001839/PS/NCHHSTP CDC HHSUnited States/ ; D43 TW001042/TW/FIC NIH HHSUnited States/ ; R01 MH066767/MH/NIMH NIH HHSUnited States/ ; K23 HD078153/HD/NICHD NIH HHSUnited States/ ; R01 HD072659/HD/NICHD NIH HHSUnited States/ ; U2G PS000758/PS/NCHHSTP CDC HHSUnited States/ ; U2G PS001904/PS/NCHHSTP CDC HHSUnited States/
• Volume:
  32
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:423f86242add5dabd5676ba5134212b18785bdab9dc6ea9867440e24eb6f8cec
• Download URL:
  https://stacks.cdc.gov/view/cdc/52164/cdc_52164_DS1.pdf
• File Type:
  [PDF - 126.53 KB ]