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ORIGINAL RESEARCH |
From the Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Epidemiology and Social Medicine and Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; Klemm Analysis Group Inc, Atlanta, Georgia; Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan; Department of Medicine, Miriam and Memorial Hospitals and Brown University School of Medicine, Providence, Rhode Island; Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan.
Address reprint requests to: Denise J. Jamieson, MD, MPH, Centers for Disease Control and Prevention, Mailstop E-45, 1600 Clifton Road, Atlanta, GA 30333; E-mail: djj0{at}cdc.gov.
OBJECTIVE: To determine the natural history of bacterial vaginosis in women with or at risk for human immunodeficiency virus (HIV).
METHODS: A cohort of 854 HIV-infected women and 434 HIV-uninfected women from four US sites was followed prospectively with gynecologic exams every 6 months over a 5-year period. The prevalence, incidence, persistence, and severity of bacterial vaginosis, which was defined using a Gram-staining scoring system, were calculated using generalized estimating equation methods.
RESULTS: In adjusted analyses, HIV-infected women had a higher prevalence of bacterial vaginosis than HIV-uninfected women (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.08, 1.55). Although HIV-infected women were not more likely to have incident infections, they were more likely to have persistence of their infections (adjusted OR 1.49; 95% CI 1.18, 1.89). Similarly, immunocompromised women (CD4+ cell count less than 200 cells/µL) were more likely than HIV-infected women with higher CD4+ cell counts (more than 500 cells/µL) to have prevalent (adjusted OR 1.29; 95% CI 1.03, 1.60) and persistent (adjusted OR 1.38; 95% CI 1.01, 1.91) bacterial vaginosis infections, but not more likely to have incident infections. Immunocompromised women had more severe bacterial vaginosis by both clinical criteria (adjusted OR 1.40; 95% CI 1.08, 1.82) and by Gram-staining criteria (adjusted OR 1.50; 95% CI 1.12, 2.00).
CONCLUSIONS: Bacterial vaginosis is more prevalent and persistent among HIV-infected women, particularly among those who are immunocompromised. Immunocompromised women are more likely than HIV-infected women with higher CD4+ cell counts to have severe bacterial vaginosis.
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