Disturbances of vaginal flora are common among women of reproductive age. In areas of sub-Saharan Africa where the prevalence of HIV is high, the frequency of bacterial vaginosis (BV) is also high. In this study, we assessed the association of BV and other disturbances of vaginal flora with prevalent HIV infection in two cross-sectional studies among pregnant women in urban Malawi. The prevalence of HIV-1 was 23% in 1990 and 30% in 1993. Overall, 30% of the women had BV, 59% had mild or moderate disturbance of vaginal flora, and only 11% had normal vaginal flora. Increasing prevalence of HIV was significantly associated with increasing severity of disturbance of vaginal flora (p < .00001, chi2 trend test). This trend of increased prevalence persisted after controlling for concurrent sexually transmitted diseases (STDs), sexual activity, and socioeconomic factors. After multivariate adjustment for potential confounders, the odds ratio for the association of BV with prevalent HIV infection was 3.0 (95% confidence interval [CI], 2.4-3.8), that of moderate vaginal disturbance with HIV infection was 2.2 (95% CI, 1.7-2.8), and that of mild vaginal disturbance with HIV infection was 1.6 (95% CI, 1.3-2.1). Among women with BV, HIV infection was higher among younger women than older, implying more recent infection. Although these studies were cross-sectional, our data suggest that BV could be associated with increased susceptibility to HIV infection.
PIP: While ulcerative and nonulcerative STDs have been shown to be associated with HIV transmission, the potential association of HIV transmission with more frequent genital conditions which cause no inflammation of the vaginal or cervical mucosa have been inadequately studied. Bacterial vaginosis (BV) is characterized by disturbances in the vaginal flora resulting in the loss of lactobacilli, an increase in other mainly anaerobic flora, and an increased vaginal pH. Reproductive-age women commonly experience disturbances of vaginal flora, and in areas of sub-Saharan Africa in which HIV prevalence is high, there is also a high frequency of BV. The authors explored the association of BV and other disturbances of vaginal flora with prevalent HIV infection in 2 cross-sectional studies among pregnant women in urban Malawi. 23% of the 6684 women tested for HIV-1 infection in 1990 were seropositive, as well as 30% of 2464 women tested in 1993. Overall, 30% of the women had BV, 59% had mild or moderate disturbance of vaginal flora, and 11% had normal flora. An increasing prevalence of HIV was significantly associated with increasing severity of disturbance of vaginal flora, even after controlling for concurrent STDs, sexual activity, and socioeconomic factors. After multivariate adjustment for potential confounders, the odds ratio for the association of BV with prevalent HIV infection was 3.0, that of moderate vaginal disturbance with HIV infection was 2.2, and that of mild vaginal disturbance with HIV infection was 1.6. Among women with BV, HIV infection was higher among younger women than older, implying more recent infection. These findings suggest that BV could be associated with increased susceptibility to HIV infection.