Longitudinal analysis of bacterial vaginosis: findings from the hiv epidemiology research study
Obstetrics and Gynecology
OBJECTIVE: To determine the natural history of bacterial vaginosis in women with or at risk for human immunodeficiency virus (HIV). METHODS: A cohort of 854 HIV-infected women and 434 HIV-uninfected women from four US sites was followed prospectively with gynecologic exams every 6 months over a 5-year period. The prevalence, incidence, persistence, and severity of bacterial vaginosis, which was defined using a Gram-staining scoring system, were calculated using generalized estimating equation
... timating equation methods. RESULTS: In adjusted analyses, HIV-infected women had a higher prevalence of bacterial vaginosis than HIV-uninfected women (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.08, 1.55). Although HIV-infected women were not more likely to have incident infections, they were more likely to have persistence of their infections (adjusted OR 1.49; 95% CI 1.18, 1.89). Similarly, immunocompromised women (CD4؉ cell count less than 200 cells/ L) were more likely than HIV-infected women with higher CD4؉ cell counts (more than 500 cells/L) to have prevalent (adjusted OR 1.29; 95% CI 1.03, 1.60) and persistent(adjusted OR 1.38; 95% CI 1.01, 1.91) bacterial vaginosis infections, but not more likely to have incident infections. Immunocompromised women had more severe bacterial vaginosis by both clinical criteria (adjusted OR 1.40; 95% CI 1.08, 1.82) and by Gram-staining criteria (adjusted OR 1.50; 95% CI 1.12, 2.00). CONCLUSIONS: Bacterial vaginosis is more prevalent and persistent among HIV-infected women, particularly among those who are immunocompromised. Immunocompromised women are more likely than HIV-infected women with higher CD4؉ cell counts to have severe bacterial vaginosis. (Obstet Gynecol 2001;98:656 -63. © 2001 by the American College of Obstetricians and Gynecologists.)Bacterial vaginosis, a common gynecologic syndrome characterized by alterations in the vaginal microflora, has been associated with a variety of adverse obstetric and gynecologic outcomes including preterm delivery, pelvic inflammatory disease, endometritis, postpartum fever, post-hysterectomy cuff cellulitis, and postabortal infection.