AEGiS-11IAC: High prevalence of abnormal vaginal flora and bacterial vaginosis in women with or at risk for HIV infection.

11th International AIDS Conference

Vancouver, British Columbia — July 7-12, 1996

High prevalence of abnormal vaginal flora and bacterial vaginosis in women with or at risk for HIV infection.

Int Conf AIDS 1996 Jul 7-12; 11:219 (abstract no. Th.B.114)
Warren D, Klein RS, Brown W, Sobel J, Schuman P, Anderson J, Cu-Uvin S, Mayer K, Holmberg S, Duerr A; CDC, Atlanta, GA, USA. Fax: 770/488-5965. E-mail: dyw3@ccddrhl.em.cdc.gov.

OBJECTIVE: To determine prevalence of and factors associated with bacterial vaginosis (BV) in HIV - infected (HIV +) women and women at risk for HIV infection (HIV-).

METHODS: Women enrolled in the multi-site HER Study were interviewed and had a physical exam (study visits were not symptom driven). Specimens were obtained for assessment of HIV infection, sexually transmitted diseases, and gynecologic infection. BV was defined: 1) by Amsel's criteria (AC) (at least 3 of 4: abnormal vaginal discharge, elevated pH, amine odor, and clue cells) and 2) by Gram stain of vaginal smears (Nugent's scoring system: 0-3 normal, 4-6 abnormal vaginal flora, 7-10 BV). Gram stains were read by a single technologist.

RESULTS: The 820 HIV + and 426 HIV - women had similar HIV risk (51% injection drug use [IDU] 49% sexual), age (median 35 yrs), and race (58% Black, 24% White, 16% Hispanic). Median CD4 number was 375 in HIV+'s. Prevalence of BV by AC was 34% (35% HIV + and 33% HIV-, p=.53); by Gram stain 47% (48% HIV + and 44% HIV-; p=.45). Only 38% had normal vaginal flora on Gram stain. Most (76%) of Gram stain BV was asymptomatic. In multivariate analysis after adjusting for HIV status, CD4, and study site, IDU (OR 1.4 CI: 1.0-2.0); black race (OR 2.2 CI: 1.4-3.3); douching (OR 2.2 CI: 1.1-4.4); inconsistent condom use and greater than 1 male partner (OR 2.0 CI: 1.2-3.5); concurrent trichomonas (OR 7.6 CI: 3.1-18.3); and Candida colonization (OR 0.5 CI: .4-.7) were independently associated with Gram stain BV. In a separate analysis, women who only had sex with women (in the last 6 months) were 3.0 times more likely (OR 3.0 CI: 1.3-7.0) and women who only had sex with men (in the last 6 months) were 1.7 times more likely (OR 1.7 CI: 1.2-2.4) than women who were not sexually active to have Gram stain BV.

CONCLUSIONS: Prevalence of BV and altered vaginal flora is extremely high in HIV + and at risk HIV - women; most are asymptomatic. Sexual transmission of BV is suggested by its markedly increased prevalence in sexually active women (heterosexual, lesbian and bisexual) compared to women who are not sexually active.

Keywords: AEGIS, Vaginosis, Bacterial, HIV Infections, Prevalence, Sexually Transmitted Diseases, Risk, Risk Factors, Human, Female, Male, epidemiology, ICA11

960707
ThB114