Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.

<h4>Background</h4>Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudina...

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Autores principales: Nicola Low, Matthew F Chersich, Kurt Schmidlin, Matthias Egger, Suzanna C Francis, Janneke H H M van de Wijgert, Richard J Hayes, Jared M Baeten, Joelle Brown, Sinead Delany-Moretlwe, Rupert Kaul, Nuala McGrath, Charles Morrison, Landon Myer, Marleen Temmerman, Ariane van der Straten, Deborah Watson-Jones, Marcel Zwahlen, Adriane Martin Hilber
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Publicado: Public Library of Science (PLoS) 2011
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spelling oai:doaj.org-article:1fc587347a32419ca988d98b19bb3c242021-11-18T05:41:55ZIntravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.1549-12771549-167610.1371/journal.pmed.1000416https://doaj.org/article/1fc587347a32419ca988d98b19bb3c242011-02-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/21358808/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition.<h4>Methods and findings</h4>We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2) values 0.0%-16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001), respectively.<h4>Conclusions</h4>This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors' Summary.Nicola LowMatthew F ChersichKurt SchmidlinMatthias EggerSuzanna C FrancisJanneke H H M van de WijgertRichard J HayesJared M BaetenJoelle BrownSinead Delany-MoretlweRupert KaulNuala McGrathCharles MorrisonLandon MyerMarleen TemmermanAriane van der StratenDeborah Watson-JonesMarcel ZwahlenAdriane Martin HilberPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 8, Iss 2, p e1000416 (2011)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
spellingShingle Medicine
R
Nicola Low
Matthew F Chersich
Kurt Schmidlin
Matthias Egger
Suzanna C Francis
Janneke H H M van de Wijgert
Richard J Hayes
Jared M Baeten
Joelle Brown
Sinead Delany-Moretlwe
Rupert Kaul
Nuala McGrath
Charles Morrison
Landon Myer
Marleen Temmerman
Ariane van der Straten
Deborah Watson-Jones
Marcel Zwahlen
Adriane Martin Hilber
Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.
description <h4>Background</h4>Identifying modifiable factors that increase women's vulnerability to HIV is a critical step in developing effective female-initiated prevention interventions. The primary objective of this study was to pool individual participant data from prospective longitudinal studies to investigate the association between intravaginal practices and acquisition of HIV infection among women in sub-Saharan Africa. Secondary objectives were to investigate associations between intravaginal practices and disrupted vaginal flora; and between disrupted vaginal flora and HIV acquisition.<h4>Methods and findings</h4>We conducted a meta-analysis of individual participant data from 13 prospective cohort studies involving 14,874 women, of whom 791 acquired HIV infection during 21,218 woman years of follow-up. Data were pooled using random-effects meta-analysis. The level of between-study heterogeneity was low in all analyses (I(2) values 0.0%-16.1%). Intravaginal use of cloth or paper (pooled adjusted hazard ratio [aHR] 1.47, 95% confidence interval [CI] 1.18-1.83), insertion of products to dry or tighten the vagina (aHR 1.31, 95% CI 1.00-1.71), and intravaginal cleaning with soap (aHR 1.24, 95% CI 1.01-1.53) remained associated with HIV acquisition after controlling for age, marital status, and number of sex partners in the past 3 months. Intravaginal cleaning with soap was also associated with the development of intermediate vaginal flora and bacterial vaginosis in women with normal vaginal flora at baseline (pooled adjusted odds ratio [OR] 1.24, 95% CI 1.04-1.47). Use of cloth or paper was not associated with the development of disrupted vaginal flora. Intermediate vaginal flora and bacterial vaginosis were each associated with HIV acquisition in multivariable models when measured at baseline (aHR 1.54 and 1.69, p<0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p<0.001), respectively.<h4>Conclusions</h4>This study provides evidence to suggest that some intravaginal practices increase the risk of HIV acquisition but a direct causal pathway linking intravaginal cleaning with soap, disruption of vaginal flora, and HIV acquisition has not yet been demonstrated. More consistency in the definition and measurement of specific intravaginal practices is warranted so that the effects of specific intravaginal practices and products can be further elucidated. Please see later in the article for the Editors' Summary.
format article
author Nicola Low
Matthew F Chersich
Kurt Schmidlin
Matthias Egger
Suzanna C Francis
Janneke H H M van de Wijgert
Richard J Hayes
Jared M Baeten
Joelle Brown
Sinead Delany-Moretlwe
Rupert Kaul
Nuala McGrath
Charles Morrison
Landon Myer
Marleen Temmerman
Ariane van der Straten
Deborah Watson-Jones
Marcel Zwahlen
Adriane Martin Hilber
author_facet Nicola Low
Matthew F Chersich
Kurt Schmidlin
Matthias Egger
Suzanna C Francis
Janneke H H M van de Wijgert
Richard J Hayes
Jared M Baeten
Joelle Brown
Sinead Delany-Moretlwe
Rupert Kaul
Nuala McGrath
Charles Morrison
Landon Myer
Marleen Temmerman
Ariane van der Straten
Deborah Watson-Jones
Marcel Zwahlen
Adriane Martin Hilber
author_sort Nicola Low
title Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.
title_short Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.
title_full Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.
title_fullStr Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.
title_full_unstemmed Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis.
title_sort intravaginal practices, bacterial vaginosis, and hiv infection in women: individual participant data meta-analysis.
publisher Public Library of Science (PLoS)
publishDate 2011
url https://doaj.org/article/1fc587347a32419ca988d98b19bb3c24
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