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Review
. 2008 Jul 31;22(12):1493-501.
doi: 10.1097/QAD.0b013e3283021a37.

Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies

Julius Atashili  1 , Charles Poole, Peter M Ndumbe, Adaora A Adimora, Jennifer S Smith
Affiliations
Review

Bacterial vaginosis and HIV acquisition: a meta-analysis of published studies

Julius Atashili et al. AIDS. .

Abstract

Objectives: To assess and summarize the published literature on the extent to which bacterial vaginosis may increase the risk of HIV acquisition.

Design: Meta-analysis of published studies.

Methods: Medline and other electronic databases were systematically searched for eligible publications. The association between bacterial vaginosis and incident HIV was separately analyzed from that between bacterial vaginosis and prevalent HIV. The latter was further analyzed, stratified by bacterial vaginosis diagnostic method, HIV risk profile of the study population, and whether or not adjusted estimates were presented.

Results: Twenty-three eligible publications were identified, including a total of 30,739 women. Bacterial vaginosis was associated with an increased risk of HIV acquisition in HIV-incidence studies (relative risk = 1.6, 95% confidence interval: 1.2, 2.1). All but one of 21 HIV-prevalence studies reported estimates above the null. The latter results were heterogeneous and showed some evidence of funnel plot asymmetry, precluding the estimation of a single summary measure. The association between bacterial vaginosis and HIV in prevalence studies appeared stronger for women without high-risk sexual behavior.

Conclusion: Bacterial vaginosis was consistently associated with an increased risk of HIV infection. High bacterial vaginosis prevalence may result in a high number of HIV infections being attributable to bacterial vaginosis. More prospective studies are needed to accurately evaluate the role of bacterial vaginosis in HIV acquisition in low-risk versus high-risk women. Furthermore, randomized clinical trials may be worth considering to determine the effect of bacterial vaginosis control measures on HIV acquisition.

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Figures

Figure 1
Figure 1. Forest plot of relative risk estimates of incident HIV infection by bacterial vaginosis status, stratified by HIV risk group
Studies are identified by the first author and the publication year. The horizontal lines represent the 95% confidence intervals. Overall heterogeneity p=0.7
Figure 2
Figure 2. Forest plot of estimates of the association of prevalent HIV infection with bacterial vaginosis, stratified by HIV risk
Studies are identified by the first author and the publication year. The horizontal lines represent the 95% confidence intervals. Heterogeneity p-value in low HIV risk group = 0.002. Heterogeneity p-value in high HIV risk group <0.0001. Overall heterogeneity p<0.0001.
Figure 3
Figure 3. Funnel plot of estimates of the association of prevalent HIV infection with bacterial vaginosis
The full circles represent real study estimates while the blank circles are the imputed estimates from a ‘trim and fill’ analysis.
See this image and copyright information in PMC

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