A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy

Abstract

BackgroundTrichomonas vaginalis has been associated with increased vaginal HIV-1 RNA shedding in antiretroviral therapy (ART)-naïve women. The effect of trichomoniasis on vaginal HIV-1 shedding in ART-treated women has not been characterized. We tested the hypothesis that T. vaginalis infection would increase vaginal HIV-1 RNA shedding in women on ART, and that successful treatment would reduce vaginal HIV-1 RNA levels.MethodsWe conducted a prospective cohort study including monthly follow-up of 147 women receiving ART in Mombasa, Kenya. Those with T. vaginalis infection, defined by the presence of motile trichomonads on vaginal saline wet mount, received treatment with single dose metronidazole (2 g). Test of cure was performed at the next monthly visit. Using the pre-infection visit as the reference category, we compared detection of vaginal HIV-1 RNA before versus during and after infection using generalized estimating equations. A cut-off of 100 HIV-1 RNA copies/swab was used as the lower limit for linear quantitation.ResultsAmong 31 women treated for trichomoniasis, the concentration of vaginal HIV-1 RNA was above the limit for quantitation before, during, and after T. vaginalis infection in 4 (13% [95% CI 4% - 30%]), 4 (13% [95% CI 4% - 30%]), and 5 (16% [95% confidence interval {CI} 5% - 34%]) women respectively. After adjusting for potential confounding factors, we could detect no difference in the likelihood of detecting vaginal HIV-1 RNA before versus during infection (odds ratio [OR] 1.41, 95% CI 0.23 - 8.79, p = 0.7). In addition, detection of HIV-1 RNA was similar before infection versus after successful treatment (OR 0.68, 95% CI (0.13 - 3.45), p = 0.6).ConclusionDetection of vaginal HIV-1 RNA during ART was uncommon at visits before, during and after T. vaginalis infection.

Integrating Prevention Interventions for People Living With HIV Into Care and Treatment Programs

“…73 Similarly, treatment of T. vaginalis was not associated with reductions in genital tract viral load. 82,87 Taken together, these findings provide good evidence that STI assessment and treatment is likely to have a low impact on preventing HIV incidence at either the individual or population level.…”

Women infected with HIV and the impact of associated sexually transmitted infections

“…When performed correctly, treatment is associated with a decrease in HIV viral load in vaginal secretions. In patients undergoing antiretroviral therapy, the presence of vaginal HIV‐RNA is uncommon before, during, and after treatment for trichomoniasis, as demonstrated by Masese et al., and highlights the importance of clinical follow‐up and antiretroviral therapy in HIV‐positive women.…”

“…The literature review identified 108 articles that associated sexually transmitted infections with HIV‐infected women. Among these articles, 33 were chosen based on the abstract and 9 were excluded owing to the criteria given above, leaving 24 articles in the analysis . The results from these articles on the influence of HIV on the prevalence, course, and treatment of other sexually transmitted infections are synthetized in Table .…”

The Role of Sexually Transmitted Infections in HIV-1 Progression: A Comprehensive Review of the Literature

“…Similarly, studies have shown that men with urethritis have higher HIV-1 RNA concentrations in semen if infected with T. vaginalis than those with urethritis of an unidentified cause [ 167 ]. Data regarding HIV-1 patients receiving ART have shown that detection of vaginal HIV-1 RNA was not different before or during a T. vaginalis infection, suggesting that CART generally maintains low or undetectable genital HIV-1 levels, even in the presence of this STI [ 168 ].…”