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Trichomonas vaginalis and HIV infection acquisition: a systematic review and meta-analysis
  1. Simon Chengo Masha1,2,3,
  2. Piet Cools2,
  3. Eduard J Sanders1,4,
  4. Mario Vaneechoutte2,
  5. Tania Crucitti5
  1. 1 Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute, Kilifi, Kenya
  2. 2 Laboratory for Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  3. 3 Department of Biological Sciences, Pwani University, Kilifi, Kenya
  4. 4 Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  5. 5 HIV/STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerpen, Belgium
  1. Correspondence to Simon Chengo Masha, Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute, Kilifi, Kenya; schengo{at}


Objectives Trichomoniasis is the most prevalent curable STI globally, with the highest incidence and prevalence in sub-Saharan Africa (sSA). STIs have largely been associated with an increase in HIV acquisition. Our objective was to assess the existing literature available in English regarding the association of Trichomoniasis and HIV-1 acquisition.

Methods The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42018082702. We searched MEDLINE, Embase and Scopus databases to collect articles measuring the association of Trichomonas vaginalis infection and HIV acquisition and performed a meta-analysis and qualitative synthesis of the literature.

Results We identified 1806 unduplicated citations, of which 18 papers and 1 conference abstract were eligible for inclusion in the review after applying our inclusion and exclusion criteria. All the studies included in the systematic review had been carried out in sSA. The articles reported various measures of effects, namely: HRs, rate ratios, risk ratios and ORs. In a meta-analysis restricted to 11 studies reporting HR, individuals infected with T. vaginalis were 1.5 times more likely to acquire HIV compared with individuals not infected with T. vaginalis (95% CI 1.3 to 1.7; p<0.001).

Conclusions T. vaginalis is an important factor in HIV acquisition especially in sSA where the prevalence of both T. vaginalis and HIV-1 are high. This systematic review and meta-analysis confirms the evidence that infection with T. vaginalis augments HIV acquisition with 50%. Diagnosis and treatment of T. vaginalis infection in both high-risk and low-risk individuals may be a potential tool to reduce new HIV infections.

Trial registration number CRD42018082702

  • trichomonas
  • HIV
  • Africa
  • systematic review
  • meta-analysis

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  • SCM and PC shared first authorship.

  • Handling editor Jackie A Cassell

  • Contributors SCM, PC and TC designed the study. SCM and PC searched for literature, reviewed titles and abstracts for inclusion in the review, performed data extraction and conducted the analysis. SCM wrote the first draft of the manuscript. All authors contributed to data interpretation, reviewed successive drafts and approved the final version of the manuscript.

  • Funding This research has been supported by a PhD Scholarship for SCM from the Belgian Development Cooperation through VLIR-UOS. The funder had no role in the in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. The views expressed here are those of the authors and do not necessarily represent the views of the Belgian Development Cooperation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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