Bacterial vaginosis (BV) is associated with an increased
risk of HIV transmission, and intravaginal practices (IVP) are an important
risk factor for developing BV. The relationship between IVP, BV and HIV lower
genital shedding, responsible for HIV transmission, has not been examined in
women receiving antiretrovirals in Zambia.
Setting: Community Health Center in Lusaka, Zambia.
Participants were HIV-infected women receiving
antiretroviral therapy and engaging in IVP (n=128). Participants completed
audio computer-administered self-interviews to assess IVP and underwent a
vaginal examination. BV was diagnosed using Nugent criteria. HIV-1 lower
genital shedding was assessed by measuring HIV-1 RNA in cervicovaginal lavages.
Most women engaged in IVP daily (114, 89.0%) and 81 (63.3%)
of the participants had BV. HIV-1 genital shedding was detected in 18 (14.2%)
participants. BV was associated with daily use of IVP and weekly use of traditional medicines for
IVP. The only factor associated with HIV-1
lower genital shedding was plasma viraemia. Neither IVP nor BV were associated with HIV shedding.
Despite the frequency of IVP and high prevalence of BV,
plasma viraemia was the primary factor associated with HIV lower genital
shedding. These findings support early initiation of antiretrovirals as an HIV
prevention tool. Given adverse health outcomes associated with BV, the
association between frequent IVP and BV, and the powerful local norms and
traditions encouraging IVP, there is a need for studies assessing culturally
tailored interventions to decrease BV in high-prevalence settings.
Full article at: http://goo.gl/EmtqVd
By:
- 1Division of Infectious Diseases, University of Miami, Miller School of Medicine, Miami, Florida, USA.
- 2University of Zambia, University Teaching Hospital, Lusaka, Zambia.
- 3Department of Epidemiology and Public Health, University of Miami, Miller School of Medicine, Miami, Florida, USA.
- 4Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, Florida, USA.
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