MOAC0202 - Oral Abstract Session
Association of bacterial vaginosis with female-to-male HIV-1 transmission among HIV-1 discordant couples in Sub-Saharan Africa
Presented by Craig R Cohen (United States).
C.R. Cohen1, J.R. Lingappa2, J.M. Baeten3, M.O. Ngayo4, C.A. Spiegel5, T. Hong6, D. Donnell7, C. Celum3, S. Kapiga8, S. Delany9, E.A. Bukusi4, Partners in Prevention HSV/HIV Transmission Study Team
1University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, United States, 2University of Washington, Global Health, Medicine, and Pediatrics, Seattle, United States, 3University of Washington, Global Health, Medicine, and Epidemiology, Seattle, United States, 4Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya, 5University of Wisconsin, Pathology and Laboratory Medicine, Madison, United States, 6University of Washington, Global Health, Seattle, United States, 7Fred Hutchinson Cancer Research Center, Statistical Center for HIV/AIDS Research and Prevention, Sea, United States, 8Harvard School of Public Health, Global Health and Population, Boston, United States, 9University of Witwatersrand, Reproductive Health Research Unit, Johannesburg, South Africa
Background: While bacterial vaginosis (BV) increases HIV-1 shedding from the female genital tract its impact on HIV-1 transmission to male partners has not been assessed.
Methods: We measured the effect of BV (Nugent's score 7-10) compared to normal vaginal flora (Nugent's score 0-3) on female-to-male HIV-1 transmission risk in a prospective study of African HIV-1 serodiscordant heterosexual couples recruited from 7 East and southern African countries. Participants were followed for up to 24 months; vaginal Gram stains obtained every three months were evaluated using Nugent's criteria. To reduce misclassification, HIV-1 transmissions to men were restricted to those linked within the partnership by viral sequence analysis.
2236 HIV-1 seronegative men with an HIV-1 seropositive female partner were enrolled. HIV-1 incidence in men whose HIV-1 infected female partners had BV three-months prior to detecting HIV-1 seroconversion was 2.87 (hazard ratio (HR) 3.09, 95%CI 1.58-6.06) versus 0.88 per 100 person-years in men whose female partners had normal vaginal flora. After controlling for sociodemographic factors, sexual behavior, male circumcision, sexually transmitted infections at enrollment, and pregnancy and plasma HIV-1 RNA in female partners, men whose HIV-infected female partners had BV the three-months prior to identifying HIV-1 seroconversion (adjusted (A)HR 2.83, 95%CI 1.29-6.22) and at the same visit (AHR 3.64, 95%CI 1.68-7.90) had an increased incidence of HIV-1 compared to men whose female partners had normal vaginal flora.
Conclusion: This study is the first to demonstrate an association between BV in HIV-1 infected female partners and their risk of HIV-1 transmission to their male partners. Normalization of vaginal flora in HIV-1 infected women could mitigate female-to-male HIV-1 transmission.
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