BACTERIAL VAGINOSIS AND DISTURBANCES OF VAGINAL FLORA - ASSOCIATION WITH INCREASED ACQUISITION OF HIV

Background: Cross-sectional studies suggest an association between bac terial vaginosis (BV) and HIV-1 infection. However, an assessment of a temporal effect was not possible. Objectives: To determine the associ ation of BV and other disturbances of vaginal flora with HIV seroconve rsion among pregnant and postnatal women in Malawi, Africa. Design: Lo ngitudinal follow-up of pregnant and postpartum women. Methods: Women attending their first antenatal care visit were screened for HIV after counselling and obtaining informed consent. HIV-seronegative women we re enrolled and followed during pregnancy and after delivery. These wo men were again tested for HIV at delivery and at 6-monthly visits post natally. Clinical examinations and collection of laboratory specimens (for BV and sexually transmitted diseases) were conducted at screening and at the postnatal 6-monthly visits. The diagnosis of BV was based on clinical criteria. Associations of BV and other risk factors with H IV seroconversion, were examined using contingency tables and multiple logistic regression analyses on antenatal data, and Kaplan-Meier prop ortional hazards analyses on postnatal data. Results: Among 1196 HIV-s eronegative women who were followed antenatally For a median of 3.4 mo nths, 27 women seroconverted by time of delivery. Postnatally, 97 sero conversions occurred among 1169 seronegative women who were followed f or a median of 2.5 years. Bacterial vaginosis was significantly associ ated with antenatal HIV seroconversion (adjusted odds ratio = 3.7) and postnatal HIV seroconversion (adjusted rate ratio = 2.3). There was a significant trend of increased risk of HIV seroconversion with increa sing severity of vaginal disturbance among both antenatal and postnata l women. The approximate attributable risk of BV alone was 23% for ant enatal HIV seroconversions and 14% for postnatal seroconversions. Conc lusions: This prospective study suggests that progressively greater di sturbances of vaginal flora, increase HIV acquisition during pregnancy and postnatally. The screening and treating of women with BV could re store normal flora and reduce their susceptibility to HIV. (C) 1998 Li ppincott Williams & Wilkins.