Jeanne Dumestre

Trichomonas vaginalis treatment reduces vaginal HIV-1 shedding.

Background: Vaginal HIV-1 shedding has been associated with Trichomonas vaginalis (TV) infection and could play a role in HIV transmission. The purpose of the study was to examine if effective TV treatment reduces the presence of vaginal HIV-1 RNA. Methods: TV+ women attending an HIV outpatient clinic in New Orleans, LA, who resolved infection (n = 58) and TV-negative controls (n = 92), matched on antiretroviral therapy (ART) were examined and interviewed at baseline, 1, and 3 months. TV status was tested by culture and the amount of cell free HIV-1 RNA in the vaginal fluids was determined by the Amplicor HIV-1 Monitor ultrasensitive assay. Results: Most women (81.3%) were black and the mean age was 37.5 (SD 8.7). At baseline, 46.0% had plasma HIV-1 RNA ≥10,000 copies/mL, 26.4% had CD4<200 cells/&mgr;L, 54.7% were taking ART, and only 26.0% had detectable HIV-1 RNA in their vaginal fluids. TV-positive women who were effectively treated for TV were less likely to shed HIV vaginally at 3-months post-treatment compared to baseline (R.R. 0.34, 95% CI: 0.12–0.92, P = 0.03), whereas there was no change for TV-negative women. Conclusion: This study provides additional support that reducing TV infection among HIV-positive women may have an impact on the prevention of HIV transmission. Reasons for the delayed treatment effect and the effect on cervical shedding need further investigation.

Detection of Human Papillomavirus DNA in Urine Specimens from Human Immunodeficiency Virus-Positive Women

ABSTRACT Human immunodeficiency virus (HIV)-positive women may represent one of the fastest-growing populations at risk for acquiring cervical cancer and thus require frequent screening. The purpose of the present studies was to validate a PCR-based urine assay by comparing detection and genotyping of human papillomavirus (HPV) DNA in urine samples and matching cervical swab specimens of HIV-positive women. Despite a difference in amplifiability, the prevalence of any HPV genotype (58% for the cervical swab specimens and 48% for the urine specimens) was not significantly different in this population. The levels of concordance were 70, 71, and 78% for detection of any HPV type, any high-risk HPV type, or any low-risk HPV type in the two specimen types, respectively. While instances of discordant detection were greater for the cervical swab specimens than for the urine specimens, this was not statistically significant. The distributions of HPV genotypes were similar in the cervix and the urine for the majority of types examined. Importantly, detection of HPV DNA in urine was associated with an abnormal Papanicolaou smear to the same extent that detection of HPV DNA in a cervical swab specimen was. These data provide preliminary support for the proposal to use urine testing as a primary or secondary screening tool for cervical cancer in HIV-positive women or as an epidemiological tool. Additional studies with larger sample sizes must be conducted in order to further verify these findings.

Vaginal Swabs Versus Lavage for Detection of trichomonas vaginalis and Bacterial Vaginosis Among Hiv-positive Women

Objectives: Cervicovaginal lavage (CVL) is often used for research and may be easier and more accurate than vaginal swabs as a specimen collection method. Goal: The goal of this study was to compare (CVL) with vaginal swabs for the detection of bacterial vaginosis (BV) and Trichomonas vaginalis (TV). Study: CVL and vaginal swabs were collected from 216 HIV-infected women. Clinical assessments were made using wet mount for TV and Amsel’s criteria for BV through CVL and swab collection methods. Laboratory gold standards used were Nugent’s criteria for BV and InPouch (Biomed Diagnostics, San Jose, CA) culture for TV collected by swab. Results: The prevalence by gold standards for BV was 49.3% and for TV was 25.2%. Sensitivities for direct microscopy versus culture for TV were 72.2 for CVL and 52.8 for vaginal swab (P <0.05). Sensitivities for Amsel’s versus Nugent’s criteria for BV were 36.2 for CVL and 34.0 for vaginal swab (P <0.80). Kappa scores of agreement between CVL and vaginal swabs for BV and TV were excellent for both. Conclusion: CVL was comparable to vaginal swabs as a specimen collection method for these 2 lower genital tract infections and may be superior for the diagnosis of TV.

Incidence of three sexually transmitted diseases during a safer sex promotion program for HIV-infected women

Promotion of safer sex practices typically includes education, skills building, and condom distribution. To evaluate the impact of such promotions and describe risk factors for sexually transmitted disease (STD), a retrospective review of 741 sexually active HIV-infected women was conducted. The cohort was African-American (82%), at least 22 years of age (81%), acquired HIV through sex (36%), had a CD4 count above 200/ mm3 (76%), and had a history of substance (alcohol or drug) use (38%). Those with incident STD (14.7%) were more likely to be under 22 years of age, to have a history of substance use, and to have an STD at entry. Traditional methods of promoting safer sex practices should be enhanced by other options such as regular screening, partner treatment, and the use of microbicides and other female-controlled methods.

Women and Human Immunodeficiency Virus: Unique Management Issues

Women currently account for an increasing proportion of the US population infected with human immunodeficiency virus (HIV). Although women suffer from similar HIV-related complications as men, they also can have unique gynecologic manifestations, such as cervical dysplasia or severe pelvic inflammatory disease. Other gender-specific management issues include contraception and pregnancy. Fortunately, today the perinatal HIV transmission rate can be lowered to less than 2% with appropriate management. More couples, including those discordant for HIV infection, are opting to pursue conception. Providers caring for HIV-infected women should be knowledgeable about reproductive choices, including the full array of available options. Strategies shown to improve access of health care to HIV-infected women include integrating gynecologic services with primary care, daily availability of medical services, provision of transportation, and provision of on-site childcare.