O1-S05.06 Association between prevalent<i>Bacterial vaginosis</i>(BV) and HIV Infection among female sex workers at two African and two Indian sites

Background BV is the most common female genital infection, particularly in developing countries and reaches its highest prevalence among female sex workers (FSWs). Over the past decade, evidence has accumulated as to its role in HIV acquisition. If BV actually plays such a role, even a modest relative risk would yield an important attributable risk for HIV, particularly in developing countries where FSWs play a pivotal role in the dynamics of HIV epidemics. Yet, data on this association among FSWs are still scanty. We analysed data from high risk women screened prior to participation in a microbicide trial to estimate BV and HIV respective prevalence and to study their association, in the presence or not of other STIs. Methods Data from Kampala, Cotonou, Chennai and Mudhol/Jhamkandi sites were analysed. Socio-demographic, behavioural and medical data were collected through individual interviews. Blood was taken for HIV and syphilis antibody testing. Genital samples were collected for BV diagnosis using Nugent scoring system, of gonorrhoea and chlamydias by SDA and of trichomoniasis (TV) and candidiasis on wet mount. Binomial log regression was used to estimate HIV prevalence ratio (PR) in relation to BV. Fitting of multivariable models was done with backward selection using the approach of proportional change of the PR. Product terms from BV and each of other STIs were included in the final model. Significance level was set at 5% for testing associations and 15% for interactions. Results Out of 1491 FSWs, BV data were available for 1367 among whom, BV and HIV prevalences were 47.6% (95% CI=45.0% to 50.3%) and 27.0% (95% CI=24.6% to 29.3%) respectively. In multivariable analysis (Abstract O1-S05.06 table 1), adjusting for site, age, years of education, occupation, current contraceptive method, oral sex, past history of STI, gonorrhoea, candidiasis and syphilis, BV was significantly associated to HIV (adjusted PR=1.20, 95% CI=1.01% to 1.42%, p=0.03). In addition, the PR was negatively modified by TV, whose prevalence was 6.7%: PR was 1.25 (1.05 to 1.48) and 0.76 (0.41 to 1.38) in the absence and the presence of TV respectively (p for interaction =0.12). Abstract O1-S05.06 Table 1 Final multivariate model *describing association betweenBacterial vaginosisand HIV infection with effect modification by Trichomoniasis, among 1367 FSWs recruited at 2 African and 2 Indian sites Variables HIV prevalence by exposure level: ni/Ni(%) Adjusted PR§ 95% CI p value Bacterial vaginosis: Positive 192/651 (29.49) 1.25 1.05 to 1.48 0.01 Negative 177/716 (24.72) 1.00 – – Site: Mudhol/Jhamkandi 23/49 (46.94) 1.06 0.71 to 1.58 0.78 Cotonou 123/447 (27.52) 0.63 0.50 to 0.79 <0.0001 Chennai 56/355 (15.77) 0.50 0.33 to 0.76 0.001 Kampala (Ref.) 167/516 (32.36) 1.00 – – Past history of STI: Yes 198/615 (32.20) 1.43 1.21 to 1.70 <0.0001 No 171/752 (22.74) 1.00 – – Exerting an occupation besides commercial sex work: Yes 243/906 (26.82) 0.82 0.65 to 1.03 0.09 No 126/461 (27.33) 1.00 – – Current contraceptive method †: Hormonal 65/221 (29.41) 0.76 0.43 to 1.34 0.34 IUD 3/11 (27.27) 0.99 0.35 to 2.82 0.98 Female sterilisation 43/294 (14.63) 0.54 0.31 to 0.94 0.03 Condom 248/809 (30.66) 0.89 0.53 to 1.50 0.67 None (Ref.) 10/31 (32.26) 1.00 – – Oral sex in the past 30 days: Yes 5/30 (16.67) 0.58 0.35 to 0.95 0.03 No 364/1337 (27.23) 1.00 – – Age (years): 15–19 (Ref.) 10/66 (15.15) 1.00 – – 20–24 100/380 (26.32) 1.85 1.03 to 3.34 0.04 25–29 109/357 (30.53) 2.23 1.24 to 4.00 0.01 30–34 68/221 (30.77) 2.70 1.50 to 4.88 0.001 35–60 82/343 (23.91) 2.25 1.23 to 4.11 0.01 Education duration (years) 0–6 240/782 (30.69) 1.00 – – 7–12 124/548 (22.63) 0.76 0.63 to 0.92 0.005 13–17 5/37 (13.51) 0.50 0.22 to 1.13 0.10 Gonorrhoea‡: Positive 52/111 (46.85) 1.52 1.26 to 1.83 <0.0001 Negative 316/1253 (25.22) 1.00 – – Candidiasis: Positive 118/421 (28.03) 1.20 0.99 to 1.45 0.06 Negative 251/946 (26.53) 1.00 – – Syphilis‡: Positive 29/82 (35.37) 1.26 0.96 to 1.67 0.09 Negative 339/1282 (26.44) 1.00 – – Trichomoniasis‡: Positive 29/82 (35.37) 1.20 0.82 to 1.74 0.34 Negative 339/1282 (26.44) 1.00 – – BV_TV¶ – 0.61 0.32 to 1.13 0.12 1.00 – – *This model includes, besides the site, all other covariables with p value <0.10 (though removal of neither resulted in a substantial change in the PR estimate during the confounders selection process), as well as TV and the product term between BV and TV. † = 1 missing value. ‡ = 3 missing values. § PR=prevalence ratio. ¶ BV_TV=product term between Bacterial Vaginosis (BV) and Trichomoniasis (TV). Conclusions Though its cross-sectional design precludes all directional interpretation of t

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