edoc

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

Low, N. and Chersich, M. F. and Schmidlin, K. and Egger, M. and Francis, S. C. and van de Wijgert H. H. M., and Hayes, R. J. and Baeten, J. M. and Brown, J. and Delany-Moretlwe S., and Kaul, R. and McGrath, N. and Morrison, C. and Myer, L. and Temmerman, M. and van der Straten A., and Watson-Jones D., and Zwahlen, M. and Martin Hilber A., . (2011) Intravaginal practices, bacterial vaginosis, and HIV infection in women : individual participant data meta-analysis. PLoS medicine, Vol. 8, H. 2 , e1000416.

Full text not available from this repository.

Official URL: http://edoc.unibas.ch/dok/A6002254

Downloads: Statistics Overview

Abstract

BACKGROUND: 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. METHODS AND FINDINGS: 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. CONCLUSIONS: 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
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Swiss Centre for International Health > Sexual and Reproductive Health (Zahorka)
UniBasel Contributors:Martin Hilber, Adriane
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:PLoS
ISSN:1549-1277
Note:Publication type according to Uni Basel Research Database: Journal article
Related URLs:
Identification Number:
Last Modified:08 Nov 2012 16:22
Deposited On:08 Nov 2012 16:12

Repository Staff Only: item control page