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Cited by 70Reproductive tract infections researchHIV/AIDS Research and InterventionsCervical Cancer and HPV Research

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Changes in the contribution of genital tract infections to HIV acquisition among Kenyan high-risk women from 1993 to 2012.

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Masese, Linnet, Baeten, Jared M., Richardson, Barbra A., Bukusi, Elizabeth, John-Stewart, Grace, Graham, Susan M., Shafi, Juma, Kiarie, James, Overbaugh, Julie, McClelland, R. Scott·2015·AIDS
DOI 10.1097/qad.0000000000000646PMC PMC4576156
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Abstract

OBJECTIVE: The objective of this study was to understand temporal trends in the contribution of different genital tract infections to HIV incidence over 20 years of follow-up in a cohort of high-risk women. DESIGN: A prospective cohort study. METHODS: We performed monthly evaluations for HIV, vaginal yeast, bacterial vaginosis, Trichomonas vaginalis, Neisseria gonorrhoeae, nonspecific cervicitis, herpes simplex virus type two (HSV-2), genital ulcer disease (GUD) and genital warts. We used Cox regression to evaluate the association between sexually transmitted infections (STIs) and HIV acquisition over four time periods (1993-1997, 1998-2002, 2003-2007, 2008-2012). Models were adjusted for age, workplace, sexual risk behaviour, hormonal contraceptive use and other STIs. The resulting hazard ratios were used to calculate population attributable risk percentage (PAR%). RESULTS: Between 1993 and 2012, 1964 women contributed 6135 person-years of follow-up. The overall PAR% for each infection was prevalent HSV-2 (48.3%), incident HSV-2 (4.5%), bacterial vaginosis (15.1%), intermediate microbiota (7.5%), vaginal yeast (6.4%), T. vaginalis (1.1%), N. gonorrhoeae (0.9%), nonspecific cervicitis (0.7%), GUD (0.8%) and genital warts (-0.2%). Across the four time periods, the PAR% for prevalent HSV-2 (40.4%, 61.8%, 58.4%, 48.3%) and bacterial vaginosis (17.1%, 19.5%, 14.7%, 17.1%) remained relatively high and had no significant trend for change over time. The PAR% for trichomoniasis, gonorrhoea, GUD and genital warts remained less than 3% across the four periods. CONCLUSION: Bacterial vaginosis and HSV-2 have consistently been the largest contributors to HIV acquisition risk in the Mombasa Cohort over the past 20 years. Interventions that prevent these conditions would benefit women's health and could reduce their risk of becoming infected with HIV.

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Authors
Masese, L., Baeten, J. M., Richardson, B. A., Bukusi, E., John-Stewart, G., Graham, S. M., Shafi, J., Kiarie, J., Overbaugh, J., & McClelland, R. S.
Affiliations
  • University of Nairobi (KE)
  • Fred Hutch Cancer Center (US)
  • Kenya Medical Research Institute (KE)
  • University of Washington (US)
Corresponding author
Masese, Linnet
ORCID
Venue
AIDS
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2015-06-01
Volume
29
Issue
9
Pages
1077-1085
ISSN
0269-9370 (ISSN-L)
DOI
10.1097/qad.0000000000000646
PMC
PMC4576156
OpenAlex
W2126758324
Cited by
70
References
36
Citations by year
2026: 4 · 2025: 3 · 2024: 3 · 2023: 3 · 2022: 10 · 2021: 8 · 2020: 6 · 2019: 9 · 2018: 9 · 2017: 9 · 2016: 5 · 2015: 1
FWCI
6.74
Type
journal article
Language
en
Open access
Locations
  • AIDS (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • University of Nairobi Research Archive (University of Nairobi) (submittedVersion)
Funders
  • National Institute of Allergy and Infectious Diseases (R37AI038518, R01 AI38518, R01AI038518, P30AI027757)
  • Fogarty International Center (D43TW000007)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (P01 HD 64915, K24HD054314, P01HD064915)
Topics
  • Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Keywords
HIV acquisition, genital tract infection, sexually transmitted infections, bacterial vaginosis, herpes simplex virus type 2, trichomoniasis, gonorrhea, genital ulcer disease, genital warts, high-risk women, temporal trends, population attributable risk, Kenya
MeSH terms
Adolescent, Adult, Female, Herpes Genitalis, Humans, Kenya, Longitudinal Studies, Middle Aged, Prospective Studies, HIV Infections, Incidence, Vaginosis, Bacterial, Risk Assessment, Young Adult, Reproductive Tract Infections

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