Effect of Treatment of Asymptomatic Bacterial Vaginosis on HIV-1 Shedding in the Genital Tract among Women on Antiretroviral Therapy: A Pilot Study (original) (raw)

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Departments of Surgery and Community Health, Alpert Medical School

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Providence, Rhode Island

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Community Health, Alpert Medical School, and Center for Statistical Sciences

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Providence, Rhode Island

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Center for Statistical Sciences

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Providence, Rhode Island

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Center for Statistical Sciences

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Providence, Rhode Island

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Division of Infectious Diseases, Departments of Medicine and Obstetrics and Gynecology, Miriam Hospital/Alpert Medical School, Brown University

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Providence, Rhode Island

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Department of Pathology and Laboratory Medicine, Emory University School of Medicine

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Atlanta, Georgia

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Department of Pathology and Laboratory Medicine, Emory University School of Medicine

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Atlanta, Georgia

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Emory Center for AIDS Research, Emory University

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Atlanta, Georgia

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Division of Infectious Diseases, Departments of Medicine and Obstetrics and Gynecology, Miriam Hospital/Alpert Medical School, Brown University

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Providence, Rhode Island

Reprints or correspondence: Dr Susan Cu-Uvin, Immunology Center, Miriam Hospital/Alpert Medical School, Brown University, Providence, RI 02906 (scu-uvin@lifespan.org).

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Published:

15 September 2009

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Carla Moreira, Kartik K. Venkatesh, Allison DeLong, Tao Liu, Jaclyn Kurpewski, Jessica Ingersoll, Angela M. Caliendo, Susan Cu-Uvin, Effect of Treatment of Asymptomatic Bacterial Vaginosis on HIV-1 Shedding in the Genital Tract among Women on Antiretroviral Therapy: A Pilot Study, Clinical Infectious Diseases, Volume 49, Issue 6, 15 September 2009, Pages 991–992, https://doi.org/10.1086/605540
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To the Editor—Bacterial vaginosis (BV) is a common and recurrent condition often characterized by an asymptomatic disturbance of the vaginal flora. Studies have shown that BV is relatively common among women infected with human immunodeficiency virus (HIV) [1] and is a risk factor for both HIV acquisition and HIV shedding in the genital tract [2, 3]. Current recommendations do not advocate treatment of asymptomatic BV [4]. This pilot study investigated whether treatment of asymptomatic BV would also have an impact on HIV-1 shedding in the genital tract of women who were already receiving highly active antiretroviral therapy (HAART).

The study comprised 30 women who were receiving HAART and who had plasma viral load <75 copies/mL during the 3 months before enrollment. Asymptomatic BV was defined by the presence of 3 of 4 Amsel criteria or a Nugent score >7 and by the absence of gynecologic symptoms. These 30 women were randomly assigned (by a nonblinded person) in a 1:1 ratio to the treatment arm or the observation arm. The treatment arm received metronidazole (500 mg twice a day for 7 days) at the initial visit, and the observation arm received no treatment. Participants returned 1 month later for follow-up. At enrollment and follow-up visits, the women were tested for HIV plasma viral load, genital tract HIV-RNA (Nuclisens, bioMérieux), sexually transmitted infections, and BV (Nugent score, Gram stain, and Amsel criteria).

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