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Intravaginal practices,bacterial vaginosis,and HIV infection in women: Individual participant data meta-analysis
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نویسنده
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low n. ,chersich m.f. ,schmidlin k. ,egger m. ,francis s.c. ,van de wijgert j.h.h.m. ,hayes r.j. ,baeten j.m. ,brown j. ,delany-moretlwe s. ,kaul r. ,mcgrath n. ,morrison c. ,myer l. ,temmerman m. ,van der straten a. ,watson-jones d. ,zwahlen m. ,hilber a.
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منبع
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plos medicine - 2011 - دوره : 8 - شماره : 2
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چکیده
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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 (i2 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. © 2011 low et al.
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آدرس
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institute of social and preventive medicine,university of bern,bern, Switzerland, centre for health policy,school of public health,university of witwatersrand,johannesburg,south africa,international centre for reproductive health,department of obstetrics and gynaecology,ghent university,ghent, Belgium, institute of social and preventive medicine,university of bern,bern, Switzerland, institute of social and preventive medicine,university of bern,bern, Switzerland, department of infectious disease epidemiology and clinical research,london school of hygiene and tropical medicine,london, United Kingdom, academic medical center of the university of amsterdam,amsterdam institute for global health and development,amsterdam, Netherlands, department of infectious disease epidemiology and clinical research,london school of hygiene and tropical medicine,london, United Kingdom, departments of global health,medicine,and epidemiology,university of washington,seattle,wa, United States, department of infectious disease epidemiology and clinical research,london school of hygiene and tropical medicine,london,united kingdom,department of epidemiology,university of california,los angeles,ca, United States, reproductive health and hiv research unit,university of witwatersrand,hillbrow, South Africa, department of medicine,university of toronto,toronto, Canada, department of infectious disease epidemiology and clinical research,london school of hygiene and tropical medicine,london,united kingdom,africa centre for health and population studies,university of kwa-zulu natal,somkhele, South Africa, clinical sciences department,fhi,research triangle park,north carolina, United States, centre for infectious diseases epidemiology and research,school of public health and family medicine,university of cape town,cape town,south africa,department of epidemiology,mailman school of public health,columbia university,new york,ny, United States, international centre for reproductive health,department of obstetrics and gynaecology,ghent university,ghent, Belgium, women's global health imperative,rti international,san francisco,ca, United States, department of infectious disease epidemiology and clinical research,london school of hygiene and tropical medicine,london, United Kingdom, institute of social and preventive medicine,university of bern,bern, Switzerland, institute of social and preventive medicine,university of bern,bern, Switzerland
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