The relative contribution of viral and bacterial sexually transmitted infections on HIV acquisition in southern African women in the Methods for Improving Reproductive Health in Africa study

Author:

Venkatesh K K12,van der Straten A34,Cheng H3,Montgomery E T3,Lurie M N12,Chipato T5,Ramjee G6,Blanchard K7,Padian N S2,Mayer K H12,de Bruyn G8

Affiliation:

1. Department of Community Health, Division of Infectious Diseases

2. Department of Medicine, Alpert Medical School, Brown University, Providence, RI, USA

3. Women's Global Health Imperative, RTI International

4. Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

5. University of Zimbabwe, Harare, Zimbabwe

6. HIV Prevention Research Unit, Medical Research Council, Durban, South Africa

7. Ibis Reproductive Health, Boston, MA, USA

8. Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa

Abstract

We assess the relative contribution of viral and bacterial sexually transmitted infections (STIs) on HIV acquisition among southern African women in a nested case-control study within the Methods for Improving Reproductive Health in Africa (MIRA) trial. Cases were women with incident HIV infection; controls were HIV-uninfected at the time of case seroconversion selected in a 1 to 3 case to control ratio (risk-set sampling), matched on study site and time of follow-up. Conditional logistic regression models were used to calculate adjusted odds ratios (AORs) and population-attributable fractions (PAF). Among 4948 enrolled women, we analysed 309 cases and 927 controls. The overall HIV incidence rate was 4.0 per 100 women-years. The incidence of HIV infection was markedly higher in women who had prevalent Herpes simplex virus type 2 (HSV-2) (AOR: 2.14; 95% confidence interval [CI]: 1.55–2.96), incident HSV-2 (AOR: 4.43; 95% CI: 1.77–11.05) and incident Neisseria gonorrhoeae (AOR: 6.92; 95% CI: 3.01–15.90). The adjusted PAF of HIV incidence for prevalent HSV-2 was 29.0% (95% CI: 16.8–39.3), for incident HSV-2 2.1% (95% CI: 0.6–3.6) and for incident N. gonorrhoeae 4.1% (95% CI: 2.5–5.8). Women's greatest risk factors for HIV acquisition were incident bacterial and viral STIs. Women-centred interventions aimed at decreasing HIV incidence in young African women need to address these common co-morbid conditions.

Publisher

SAGE Publications

Subject

Infectious Diseases,Pharmacology (medical),Public Health, Environmental and Occupational Health,Dermatology

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