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Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

Author

Listed:
  • Nicola Low
  • Matthew F Chersich
  • Kurt Schmidlin
  • Matthias Egger
  • Suzanna C Francis
  • Janneke H. H. M. van de Wijgert
  • Richard J Hayes
  • Jared M Baeten
  • Joelle Brown
  • Sinead Delany-Moretlwe
  • Rupert Kaul
  • Nuala McGrath
  • Charles Morrison
  • Landon Myer
  • Marleen Temmerman
  • Ariane van der Straten
  • Deborah Watson-Jones
  • Marcel Zwahlen
  • Adriane Martin Hilber

Abstract

Pooling of data from 14,874 women in an individual participant data meta-analysis by Nicola Low and colleagues reveals that some intravaginal practices increase the risk of HIV acquisition.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

Suggested Citation

  • Nicola Low & Matthew F Chersich & Kurt Schmidlin & Matthias Egger & Suzanna C Francis & Janneke H. H. M. van de Wijgert & Richard J Hayes & Jared M Baeten & Joelle Brown & Sinead Delany-Moretlwe & Rup, 2011. "Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis," PLOS Medicine, Public Library of Science, vol. 8(2), pages 1-14, February.
    • Handle: RePEc:plo:pmed00:1000416
    DOI: 10.1371/journal.pmed.1000416
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    Cited by:

    1. Suzanna C Francis & Yanwen Hou & Kathy Baisley & Janneke van de Wijgert & Deborah Watson-Jones & Trong T Ao & Carolina Herrera & Kaballa Maganja & Aura Andreasen & Saidi Kapiga & Gary R Coulton & Rich, 2016. "Immune Activation in the Female Genital Tract: Expression Profiles of Soluble Proteins in Women at High Risk for HIV Infection," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-28, January.

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