Is There an Association between Bacterial Vaginosis Infection and HIV-1 Infection Acquisition among Women Aged 18 - 35 Years in Soweto?

Abstract

Background: Studies suggest that there is association between Bacterial Vaginosis and Human Immunodeficiency Virus infection but its temporal effect has not been sufficiently investigated. Methods: It is a secondary data analysis following a cohort study. It was carried out to describe Bacterial Vaginosis infection association to Human Immunodeficiency Virus acquisition. The primary cohort study registered 750 study participants. A gram stain slide prepared from a vaginal swab was used to measure Bacterial Vaginosis as the primary exposure. A score of 7 or above was considered positive for Bacterial Vaginosis. The determination of the dependent variable Human Immunodeficiency Virus infection was achieved through dual rapid tests which were confirmed by using a third generation ELISA. Incident Human Immunodeficiency Virus infection rate was calculated. To test significance, Kaplan Meier survival time analysis and log rank test were carried out. The association of Bacterial Vaginosis with Human Immunodeficiency Virus infection was investigated using Cox regression. Results: The baseline prevalence of Bacterial Vaginosis was 52%, 95% CI; 45 - 59. There were 21 Human Immunodeficiency Virus seroconversions in total of which 7 had no Bacterial Vaginosis results and were left out in the analysis. The analysis only involved 14 seroconversions and these were followed for a mean time of 0.40 of a year and total time at risk of 286 person years. This shows incident rate of Human Immunodeficiency Virus infection of 4.9 per 100 person years of follow up, 95 % CI: 2.9 - 8.27. Kaplan Meier curves revealed a higher risk of incident infection among women who were Bacterial Vaginosis positive than the women who were Bacterial Vaginosis negative. A log rank test showed that the probability of incident infection differed among the women depending on Bacterial Vaginosis status, X2 value 3.8, p value 0.05. Adjusting for the other variables, incident Human Immunodeficiency Virus infection was high among Bacterial Vaginosis positive women, adjusted hazard ratio 3.21; 95% CI; 0.85 - 12.12, p value 0.08, though significance was not attained. Conclusion: The study showed an association between Bacterial Vaginosis and Human Immunodeficiency Virus seroconversion risk though statistical significance was not achieved. Education on vaginal cleansing, screening and treating women with Bacterial Vaginosis could maintain normal vaginal flora and reduce their vulnerability to Human Immunodeficiency Virus.