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Association between Mycoplasma genitalium infection and HIV acquisition among female sex workers in Uganda: evidence from a nested case–control study
  1. Judith Vandepitte1,
  2. Helen A Weiss2,
  3. Justine Bukenya1,
  4. Nassim Kyakuwa1,
  5. Etienne Muller3,
  6. Anne Buvé4,
  7. Patrick Van der Stuyft4,5,
  8. Richard J Hayes2,
  9. Heiner Grosskurth1,2
  1. 1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
  2. 2MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
  4. 4Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium
  5. 5University of Ghent, Ghent, Belgium
  1. Correspondence to Dr Judith Vandepitte, MRC/UVRI Uganda Research Unit on AIDS, PO BOX 49, Entebbe, Uganda; Jvdpitte{at}hotmail.co.uk

Abstract

Objectives Cross-sectional studies have shown a strong association between Mycoplasma genitalium and HIV infections. We previously reported that in a cohort of female sex workers in Uganda, M genitalium infection at baseline was associated with HIV seroconversion. Here we examine the temporal association between the M genitalium infection status shortly before HIV seroconversion and HIV acquisition.

Methods A nested case-control study was conducted within a cohort of women at high risk for HIV in Kampala. Cases were those of women acquiring HIV within 2 years of enrolment. For each of the 42 cases, 3 controls were selected from women HIV negative at the visit when the corresponding case first tested HIV seropositive. The association between HIV acquisition and M genitalium infection immediately prior to HIV testing was analysed using conditional logistic regression.

Results There was weak evidence of an association between M genitalium infection and HIV acquisition overall (crude OR=1.57; 95% CI 0.67 to 3.72, aOR=2.28: 95% CI 0.81 to 6.47). However, time of M genitalium testing affected the association (p value for effect-modification=0.004). For 29 case-control sets with endocervical samples tested 3 months prior to the first HIV-positive result, M genitalium infection increased the risk of HIV acquisition (crude OR=3.09; 95% CI 1.06 to 9.05, aOR=7.19; 95% CI 1.68 to 30.77), whereas there was little evidence of an association among the 13 case-control sets with samples tested at an earlier visit (crude OR=0.30: 95% CI 0.04 to 2.51; aOR=0.34; 95% CI 0.02 to 5.94).

Conclusions Our study showed evidence of a temporal relationship between M genitalium infection and HIV acquisition that suggests that M genitalium infection may be a co-factor in the acquisition of HIV infection.

  • AFRICA
  • EPIDEMIOLOGY (CLINICAL)
  • GENITAL TRACT INFECT
  • HIV WOMEN
  • M GENITALIUM

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/

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