Background
It
is well documented that the mucosal linings of the female genital tract (FGT)
usually provides a robust barrier that protects against sexually acquired
infections. However, to the best of our knowledge there are limited South
African studies that have investigated the association between damage to the
mucosal linings and the acquisition of HIV infections. We hypothesize that in
this cohort of women, a higher rate of HIV seroconversions will be observed for
women who present with evidence of mucosal damage.
Methods
We
undertook a secondary analysis of the Methods for Improving Reproductive Health
in Africa (MIRA) trial that assessed the effectiveness of the latex diaphragm and
lubricant gel on HIV prevention among women. Participants underwent a physical
examination which included a pelvic examination to detect the presence of
mucosal abnormalities. During the physical examinations, the study clinicians
examined the genitalia, cervix and vagina for signs of epithelial disruptions
and abnormal vaginal discharge. The association between the various genital
factors and HIV seroconversion was modeled using Cox proportional hazards
regression analysis.
Results
In
this cohort of 1485 women that had enrolled to participate in the study, women
that had presented with genital epithelial disruptions and abnormal vaginal
discharge were shown to be at highest risk for HIV acquisition respectively. In addition, the Kaplan Meier analysis showed that the highest
number of seroconversions was observed in women that had disrupted genital
epithelia (27 per 100/py) and abnormal vaginal
discharge (12 per 100/py). Other significant factors
included: genital signs and symptoms and genital ulcers/sores.
Conclusion
We
have shown that damage to the mucosal epithelial lining increases a women’s
risk of HIV seroconversion. Future studies that provide an in depth
understanding of the mechanisms associated with the FGT and mucosal immunity
will be most valuable. An understanding of all of these mechanisms will be key
in directing the advancement of products most suitable for combating HIV
infection in women.
Below: Kaplan Meier plots showing
the survival rates for the individual genital factors with the crude HIV
incidence rates calculated for each variable with the respective p-values. a epithelial
disruption and b abnormal vaginal discharge
Full article at: http://goo.gl/nztvyB
1HIV Prevention Research Unit, Medical Research Council,
123 Jan Hofmeyr Road, Westville, Durban 3630, South Africa
2Department of Epidemiology and Population Health,
London School of Hygiene & Tropical Medicine, London, UK
3The Kirby Institute, University of New South Wales,
Sydney 2052, NSW, Australia
More at: https://twitter.com/hiv insight
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