Ghent University Academic Bibliography

Advanced

Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis

Nicola Low, Matthew Chersich UGent, Kurt Schmidlin, Matthias Egger, Suzanna C Francis, Janneke HHM van de Wijgert, Richard J Hayes, Jared M Baeten, Joelle Brown and Sinead Delany-Moretlwe, et al. (2011) PLOS MEDICINE. 8(2).
abstract
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 (I-2 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.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
RANDOMIZED CONTROLLED-TRIAL, VAGINAL PRACTICES, SIMPLEX-VIRUS TYPE-2, SOUTH-AFRICAN WOMEN, INCREASED RISK, PREVENTION, ACQUISITION, SEX WORKERS, TRANSMISSION, TANZANIA
journal title
PLOS MEDICINE
PLos Med.
volume
8
issue
2
article_number
e1000416
pages
14 pages
Web of Science type
Article
Web of Science id
000287657600010
JCR category
MEDICINE, GENERAL & INTERNAL
JCR impact factor
16.269 (2011)
JCR rank
5/153 (2011)
JCR quartile
1 (2011)
ISSN
1549-1277
DOI
10.1371/journal.pmed.1000416
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1844409
handle
http://hdl.handle.net/1854/LU-1844409
date created
2011-06-28 16:40:41
date last changed
2011-07-13 15:12:44
@article{1844409,
  abstract     = {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 (I-2 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{\textlangle}0.001) or at the visit before the estimated date of HIV infection (aHR 1.41 and 1.53, p{\textlangle}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.},
  articleno    = {e1000416},
  author       = {Low, Nicola and Chersich, Matthew and Schmidlin, Kurt and Egger, Matthias and Francis, Suzanna C and van de Wijgert, Janneke HHM and Hayes, Richard J and Baeten, Jared M and Brown, Joelle and Delany-Moretlwe, Sinead and Kaul, Rupert and McGrath, Nuala and Morrison, Charles and Myer, Landon and Temmerman, Marleen and van der Straten, Ariane and Watson-Jones, Deborah and Zwahlen, Marcel and Hilber, Adriane Martin},
  issn         = {1549-1277},
  journal      = {PLOS MEDICINE},
  keyword      = {RANDOMIZED CONTROLLED-TRIAL,VAGINAL PRACTICES,SIMPLEX-VIRUS TYPE-2,SOUTH-AFRICAN WOMEN,INCREASED RISK,PREVENTION,ACQUISITION,SEX WORKERS,TRANSMISSION,TANZANIA},
  language     = {eng},
  number       = {2},
  pages        = {14},
  title        = {Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis},
  url          = {http://dx.doi.org/10.1371/journal.pmed.1000416},
  volume       = {8},
  year         = {2011},
}

Chicago
Low, Nicola, Matthew Chersich, Kurt Schmidlin, Matthias Egger, Suzanna C Francis, Janneke HHM van de Wijgert, Richard J Hayes, et al. 2011. “Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis.” Plos Medicine 8 (2).
APA
Low, N., Chersich, M., Schmidlin, K., Egger, M., Francis, S. C., van de Wijgert, J. H., Hayes, R. J., et al. (2011). Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis. PLOS MEDICINE, 8(2).
Vancouver
1.
Low N, Chersich M, Schmidlin K, Egger M, Francis SC, van de Wijgert JH, et al. Intravaginal practices, bacterial vaginosis, and HIV infection in women: individual participant data meta-analysis. PLOS MEDICINE. 2011;8(2).
MLA
Low, Nicola, Matthew Chersich, Kurt Schmidlin, et al. “Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis.” PLOS MEDICINE 8.2 (2011): n. pag. Print.