“Trich” now joins the list of sexually transmitted infections (syphilis, herpes, chlamydia, gonorrhea) and the non STI bacterial vaginosis that increase the risk of getting HIV. We do not know whether treating it will reduce the risk.
********************************
KENYA: Infection with Trichomonas vaginalis Increases the Risk of HIV-1
Acquisition
R. Scott McClelland; Laura Sangare; Wisal M. Hassan; Ludo Lavreys; Kishorchandra Mandaliya; James Kiarie; Jeckoniah Ndinya-Achola, Walter Jaoko; Jared M. Baeten
Journal of Infectious Diseases Vol. 195; doi:10.1086/511278 (03..07) - Friday,
February 02, 2007
In this prospective study, investigators hoped to determine whether Trichomonas
vaginalis infection is associated with an increased risk of HIV-1 infection.
From February 1993 through March 2004, HIV-1-seronegative female sex workers at a city clinic in Mombasa, Kenya, were invited to participate in an open cohort study of risk factors for HIV infection. At baseline and follow-up, participants were interviewed to determine their medical, sexual, and gynecological history.
Syndromic treatment was given for women with signs or symptoms of genital tract infection, pelvic inflammatory disease or vaginal discharge, according to Kenya Ministry of Health guidelines, or one week later for women whose tests indicated infection. HIV risk-reduction counseling and condoms were provided at every visit.
Of 1,579 HIV-negative women enrolled, 1,335 (85 percent) returned for follow-up,
yielding a slightly younger cohort (25 years vs. 26 years; P=0.02) with less
experience in sex work (0.8 vs. 1 year median; P=0.01). In the median duration of
566 days at last follow-up, there were 806 incident T. vaginalis infections and
265 HIV-1 seroconversions.
In univariate analyses, T. vaginalis infection was associated with a significant
increase in HIV-1 seroconversion (hazard ratio [HR], 1.60; 95 percent confidence
interval [CI], 1.11-2.31; P=0.01). After adjusting for sexual risk behaviors,
STDs, and potential confounders, the association remained statistically significant (adjusted HR, 1.52 [95 percent CI, 1.04-2.24]; P=0.03).
Shorter duration of sex work, lower educational attainment, and use of alcohol
were all significantly associated with T. vaginalis infection. It was also more
common among those with concurrent cervicitis or concurrent bacterial vaginosis.
Condom use and use of progesterone-only contraceptives (DMPA and Norplant) were associated with lower T. vaginalis infection risk, which held in multivariate
analyses.
"Our finding associating this infection with increased risk of HIV-1 acquisition
suggests interventions targeted toward preventing vaginal trichomoniasis could
reduce the spread of HIV," concluded authors. "There is mounting evidence that
other conditions that disrupt the normal vaginal milieu, including bacterial
vaginosis and vaginal candidiasis, also increase susceptibility to HIV-1 acquisition..
Interventions to prevent and treat trichomoniasis and to improve vaginal health
in general could provide important female- controlled methods for reducing the
risk of HIV-1 transmission to women."
