Background Mycoplasma genitalium (MG) is an emerging STI associated with reproductive tract syndromes in men and women, and with HIV in cross-sectional studies. MG is common in HIV-infected women, but there have been no longitudinal studies of MG and genital HIV RNA among HIV-infected women.
Methods The study is nested in a cohort of 131 HIV-infected, ART-naïve Zimbabwean women aged 19–37 years. Real-time PCR was used to test for presence and quantity of MG DNA in 420 stored cervical samples (1–4 visits per woman). Genital and plasma HIV viral load, CD4 count and presence of other STI and reproductive tract infections were collected at each visit, together with clinical and behavioural data. Logistic and linear random-effects models were used to analyse i) factors associated with detection of MG, and ii) the association of detection and quantity of MG with detection and quantity of genital HIV RNA.
Results MG was detected at 44/420 (10.5%) visits, with a median bacterial load of 1497 copies/ml (range <300–3 240 000 copies/ml). MG was twice as prevalent as N gonorrhoeae (5.0%) or C trachomatis (4.8%). Of the 33 women with MG detected at least once, six were infected at ≥2 consecutive visits, persisting for up to 43 weeks. In multivariable analyses, MG was independently associated with bacterial vaginosis (OR=2.24, 95% CI 1.03 to 4.85), HSV2 (OR=8.56, 95% CI 0.99 to 74.24) and younger age (OR=2.92, 95% CI 1.10 to 7.76). Cleaning inside the vagina was protective against MG infection (OR=0.33, 95% CI 0.15 to 0.71). Genital HIV RNA was detected at 237/397 (59.7%) visits, with a mean viral load of 5.14 log10 copies/ml. MG was independently associated with detection of genital HIV RNA (OR=2.73, 95% CI to 1.02–7.33) after adjusting for confounders including plasma viral load, CD4 count, HSV2, and N gonorrhoeae. Higher MG bacterial load was weakly associated with detection of genital HIV RNA (OR=1.75, 95% CI 0.96 to 3.19) but there was little association with quantity of HIV RNA.
Conclusions This cohort study confirms previous cross-sectional results showing an association of genital HIV DNA detection with MG infection. Further research is needed to explore factors mediating this association, as MG was not associated with plasma viral load or measured markers of inflammation. The growing evidence for an association of MG with HIV genital shedding, and the high prevalence and persistence of MG infection, suggests that screening and treatment of MG may be warranted among HIV-positive women.
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