1 / 23

Presenter: Guédou F. A. MD, MSc, PhD

Is bacterial vaginosis just the tip of the iceberg as to the risk of HIV related to vaginal flora abnormalities ?. Presenter: Guédou F. A. MD, MSc, PhD Co-authors: Van Damme L, Mirembe F, Solomon S, Becker M, Deese J, Crucitti T, Taylor D, Alary M. Afri-Can Forum

noelle-williamson
Download Presentation

Presenter: Guédou F. A. MD, MSc, PhD

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Is bacterial vaginosis just the tip of the iceberg as to the risk of HIV related to vaginal flora abnormalities ? Presenter: Guédou F. A. MD, MSc, PhD Co-authors: Van Damme L, Mirembe F, Solomon S, Becker M, Deese J, Crucitti T, Taylor D, Alary M Afri-Can Forum Entebbe 17-19 January 2013

  2. Overview • Background • Objectives • Methods and materials • Results • Discussion • Conclusion

  3. Background(1) • Bacterial Vaginosis (BV) is a polymicrobial infection resulting from the replacement of lactobacilli of the normal vaginal flora by a variety of bacteria, predominantly anaerobic • The main challenge of BV to date is that of the identification of its causative agent so that the current consensus is that a polymicrobial infection

  4. Background (2) Conventionally, BV is diagnosed: • Clinically on Amsel’s criteria; • Biologically with Nugent’score: • normal flora (NS = 0-3); • intermediate flora (NS = 4-6); • BV (NS = 7-10)

  5. Background (3) • BV = most common genital infection worldwide • Higher prevalence in developing countries (DC): between 9% and 50%; 70% among female sex workers (FSW)

  6. Background (4) • But what justifies the present work is that the role of BV in HIV acquisition or transmission has been strongly suggested by some studies • Since BV has such a high prevalence among FSWs, even a modest RR substantial attributable risk for HIV

  7. Background (5) • This is of uppermost interest when considering the role of core group played by FSWs in the dynamic of HIV epidemics in DC and particularly in Sub-Saharan Africa • In addition, most studies that have examined this association have classified “BV” as (BV vs. non-BV) • Very little attention has been paid to the possible role of intermediate vaginal flora (IVF) in this association

  8. Objectives • To investigate the association between HIV and respectively IVF and BV, among FSW screened prior to enrolment in the Cellulose sulfate trial • To compare the strengths of these two associations

  9. Chennai Mudhol/Jhamkandi (India): (2) Benin Uganda Kampala (Uganda): (1) Cotonou (Benin): (1) Durban (South Africa): (1) Materials and Methods (1) Settings: Sites of the CS trial

  10. Materials and Methods (2) Participants selection: Eligibility criteria: • Potential participant in the SC trial • 18 years or older • HIV high risk woman (≥ 3 different sexual partners in the last 3 months and ≥ 3 sexual acts/week) • Data available for both BV and HIV • Informed consent for screening

  11. Materials and Methods (3) Data collection • Interview: socio-demo. and behavioral data • Gynecological Exam: clinical data • Blood and cervico-vaginal swabs: • HIV: HIV antibodies test • BV: Gram and Nugent score (NS) • Gonorrhea and Chlamydia: SDA (Strand DNA Amplification) • Syphilis: RPR confirmed with TPHA • Trichomoniasis (TV) and Candidiasis: Wet mount

  12. Materials and Methods(4) Statistical analyses • Log binomial regression to model HIV prevalencewith respect to vaginal floraabnormalities: • 2 categories: BV vs. Non-BV • 3 categories : normal (reference), IVF and BV (Comparison of BV and IVF prevalence ratios) • Bivariate analyses (controlling for site) • Multivariate analyses (adjustment)

  13. Results: (1)

  14. Results (2)

  15. Discussion (1) • The aPR obtained using women with NVF as reference was substantially higher than that obtained using women without BV as reference • This is due to the fact that HIV prevalence among women with IVF was significantly higher than that of women with NVF: aPR = 1.56 (95% CI = 1.22-1.98, p = 0.0003) • The use of all women without BV (NVF/IVF) as a reference to measure the increase in HIV risk associated with BV could lead to its underestimation

  16. Discussion (2) • In addition, the strength of the association obtained with IVF was similar to that obtained with the BV (p = 0.6347) • This is in contrast with the trend of monotonic increase found in most studies that have examined the association between HIV and vaginal flora abnormalities

  17. Discussion (3): Direction of the association? • BV may increase the risk of HIVMobilization of HIV target cellsWeakening of the vaginal epithelial barrier • HIV may increase the risk of BVImmunosuppression? But no significant association between HIV and other STIs! • A risk factor common to HIV and BV (not / insufficiently controlled by analysis)

  18. Discussion (4): the study limits • Cross-sectional design • 124 eligible FSW excluded (lack of data on BV) • Inability to control for HSV-2, alcohol • Possibility of inaccuracy for some data: • Vaginal douching (quantification) • Number of sexual partners (memory) • Condom use (social desirability)

  19. Discussion (5): Strenghts of the study • Clinical trial settings: • Large sample size • An international quality control system • Use of the current gold standard for BV diagnosis • Use of log-binomial regression: which enabled a better approximation of the relative risk

  20. Conclusions • The results of this study suggest that: • BV represents only a part of the vaginal flora abnormalities associated with an increased risk of HIV; • IVF is associated with HIV as stronger as BV • Need of prospective studies to confirm findings • Implication for HIV prevention: Controlling vaginal flora abnormalities (not just BV) among FSWs may be an untapped strategy to curb HIV epidemic, particularly in countries with concentrated epidemic

  21. Acknowledgments (1) • Trial participants • Cotonou Team (Benin): • Clinical team: I. Minani; N. Geraldo; G. Ainan; C. Assogba; C. Gbenafa • Lab team: M. Loembe; E. Goma; G. Ahotin; L. Djossou; N. Tata • Sociology team: O. Azonnadou, J. Agonmounon, F. Mito-Yobo • Field team: G. Batona et coll. • Canada Team(CHU of Quebec) :M. Belleau, J. Leroux, J. Begin, L. Pagé • Other sites: • Lusaka (Ouganda): F. Mirembe et al. • Chennai (Inde): S. Solomon et al. • Mudhol/Jhamkandi (Inde): M. Becker et al.

  22. Aknowledgments (2) • International Team: • CONRAD (VA, USA): L. Van Damme (PI); • FHI (NC, USA): J. Deese; D. Taylor; • ITM (Antwerrp, Belgium) : T. Crucitti • Sponsor: CONRAD (USA) • Funders: • USAID • Fondation Bill Gates & Melinda

  23. Thanks for your kind attention

More Related