The University of Southampton
University of Southampton Institutional Repository

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

Intravaginal practices, bacterial vaginosis and HIV infection in women: individual woman data meta-analysis
Intravaginal practices, bacterial vaginosis and HIV infection in women: individual woman data meta-analysis
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.
1549-1277
Low, N.
8c6c55da-d9a4-4d4c-9149-8685fce82ada
Chersich, M.F.
9770fd36-376a-4aa3-ada9-9ea5544a0ac6
Schmidlin, K.
9e61542f-78bb-472e-9e92-b0b915ef077b
Egger, M.
95d232d3-852e-4d4b-8070-c0aff86ebe60
Francis, S.C.
4c1c75f9-824b-4557-8a73-512033c9a7da
van de Wijgert, J.H.
dd6d67b2-48ab-47e4-900e-bacaa8da79c3
Hayes, R.J.
cab45e0b-a296-4bf8-b50c-8507e329dac4
Baeten, J.M.
9e2be419-b689-490d-8e97-8d632a7db2e8
Brown, J.
64c8be68-e3cb-49ff-b5b0-525db5f4bcd0
Delany-Moretlwe, S.
0499bd79-0f61-4be5-a085-783bcc8b6fbe
Kaul, R.
950eb7fe-9fad-43c5-9dee-6896f5ef3eca
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Morrison, C.
fa62d65f-cba3-4b4b-a0fa-4a2cff256e8e
Myer, L.
faaed027-3913-4c2d-9971-879f99771d8d
Temmerman, M.
9fd6c365-8e57-4703-8fa7-c77e1dc0a294
van der Straten, A.
a6450725-b9dc-46b2-b2c0-96fd0a3f6245
Watson-Jones, D.
bf4ce52e-b71a-4323-8b89-94147b3ea582
Zwahlen, M.
34b45ce5-fec5-44cd-a33a-0a1ee25c946c
Hilber, A.M.
cbd4faf4-3d8a-4513-879c-9b1e3eb7e8b8
Low, N.
8c6c55da-d9a4-4d4c-9149-8685fce82ada
Chersich, M.F.
9770fd36-376a-4aa3-ada9-9ea5544a0ac6
Schmidlin, K.
9e61542f-78bb-472e-9e92-b0b915ef077b
Egger, M.
95d232d3-852e-4d4b-8070-c0aff86ebe60
Francis, S.C.
4c1c75f9-824b-4557-8a73-512033c9a7da
van de Wijgert, J.H.
dd6d67b2-48ab-47e4-900e-bacaa8da79c3
Hayes, R.J.
cab45e0b-a296-4bf8-b50c-8507e329dac4
Baeten, J.M.
9e2be419-b689-490d-8e97-8d632a7db2e8
Brown, J.
64c8be68-e3cb-49ff-b5b0-525db5f4bcd0
Delany-Moretlwe, S.
0499bd79-0f61-4be5-a085-783bcc8b6fbe
Kaul, R.
950eb7fe-9fad-43c5-9dee-6896f5ef3eca
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Morrison, C.
fa62d65f-cba3-4b4b-a0fa-4a2cff256e8e
Myer, L.
faaed027-3913-4c2d-9971-879f99771d8d
Temmerman, M.
9fd6c365-8e57-4703-8fa7-c77e1dc0a294
van der Straten, A.
a6450725-b9dc-46b2-b2c0-96fd0a3f6245
Watson-Jones, D.
bf4ce52e-b71a-4323-8b89-94147b3ea582
Zwahlen, M.
34b45ce5-fec5-44cd-a33a-0a1ee25c946c
Hilber, A.M.
cbd4faf4-3d8a-4513-879c-9b1e3eb7e8b8

Low, N., Chersich, M.F., Schmidlin, K., Egger, M., Francis, S.C., van de Wijgert, J.H., Hayes, R.J., Baeten, J.M., Brown, J., Delany-Moretlwe, S., Kaul, R., McGrath, N., Morrison, C., Myer, L., Temmerman, M., van der Straten, A., Watson-Jones, D., Zwahlen, M. and Hilber, A.M. (2011) Intravaginal practices, bacterial vaginosis and HIV infection in women: individual woman data meta-analysis. PLoS Medicine, 8 (2). (doi:10.1371/journal.pmed.1000416). (PMID:21358808)

Record type: Article

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.

Other
fetchObject.action_uri=info_doi%2F10.1371%2Fjournal.pmed.1000416&representation=PDF - Version of Record
Available under License Other.
Download (642kB)

More information

e-pub ahead of print date: 15 February 2011
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 350260
URI: http://eprints.soton.ac.uk/id/eprint/350260
ISSN: 1549-1277
PURE UUID: 3c613821-ea10-4c42-b563-1418caa9d831
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159

Catalogue record

Date deposited: 20 Mar 2013 14:44
Last modified: 15 Mar 2024 03:46

Export record

Altmetrics

Contributors

Author: N. Low
Author: M.F. Chersich
Author: K. Schmidlin
Author: M. Egger
Author: S.C. Francis
Author: J.H. van de Wijgert
Author: R.J. Hayes
Author: J.M. Baeten
Author: J. Brown
Author: S. Delany-Moretlwe
Author: R. Kaul
Author: N. McGrath ORCID iD
Author: C. Morrison
Author: L. Myer
Author: M. Temmerman
Author: A. van der Straten
Author: D. Watson-Jones
Author: M. Zwahlen
Author: A.M. Hilber

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×