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1 January 2005

Volume 191, Number 1
The Journal of Infectious Diseases 2005;191:25–32
© 2004 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19101-0005$15.00
DOI: 10.1086/426394
MAJOR ARTICLE

Female Genital‐Tract HIV Load Correlates Inversely with Lactobacillus Species but Positively with Bacterial Vaginosis and Mycoplasma hominis

Beverly E. Sha,1

M. Reza Zariffard,2

Qiong J. Wang,3

Hua Y. Chen,3

James Bremer,2

Mardge H. Cohen,4 and

Gregory T. Spear2

1Department of Medicine, Section of Infectious Diseases, and 2Department of Immunology/Microbiology, Rush University Medical Center, 3Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, and 4Department of Medicine, CORE Center, Cook County Bureau of Health Sciences, Chicago, Illinois

Background.Bacterial vaginosis (BV) is associated with human immunodeficiency virus (HIV) acquisition. We examined the association between BV and BV‐associated bacteria and expression of HIV in the female genital tract.

Methods.HIV RNA, lactobacilli, Gardnerella vaginalis, and Mycoplasma hominis in cervicovaginal lavage (CVL) samples were quantified by polymerase chain reaction (PCR). Gynecologic evaluation included Nugent score assessment, Amsel criteria assessment, detection of other genital‐tract infections, and dysplasia grading. CD4 cell count, plasma HIV RNA level, and antiretroviral history were obtained.

Results.A total of 203 CVL samples from women with Nugent scores of 7–10 (BV group) and 203 samples from women with Nugent scores of 0–3 (no‐BV group) were matched by plasma HIV RNA level and analyzed. After controlling for plasma HIV RNA level and Nugent score in univariate analyses, we found that G. vaginalis and M. hominis bacterial counts, Candida vaginitis, and herpes simplex virus (HSV) were positively associated with CVL HIV RNA levels. In multivariate analysis, only lactobacilli bacterial counts ( ; inverse association), M. hominis bacterial counts ( ; positive association), Candida vaginitis ( ), and HSV ( ) were significantly associated with CVL HIV RNA levels.

Conclusion.Bacteria associated with BV increase genital‐tract HIV RNA levels. Quantitative bacterial counts for lactobacilli and M. hominis are better correlates of CVL HIV RNA than are Nugent score or Amsel criteria. Since plasma virus and CD4 cell levels did not differ between the BV and no‐BV groups, these data suggest that the bacterial flora associated with BV influence genital‐tract HIV shedding.

Received 24 February 2004; accepted 12 July 2004; electronically published 2 December 2004.

Reprints or correspondence: Dr. Beverly E. Sha, 600 S. Paulina St., Ste. 143, Chicago, IL 60612 ().

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  • Presented in part: 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, 8–11 February 2004 (abstract 955).

    Financial support: National Institutes of Health (grant P01 H040539); Women’s Interagency HIV Study, which is funded by the National Institute of Allergy and Infectious Diseases, with supplemental funding from the National Cancer Institute, the National Institute on Drug Abuse, the National Institute of Dental and Craniofacial Research (grants U01‐AI‐35004, U01‐AI‐31834, U01‐AI‐34994, U01‐AI‐34989, U01‐AI‐34993, and U01‐AI‐42590), the National Institute of Child Health and Human Development (grant U01‐HD‐32632), and the National Center for Research Resources (grants MOI‐RR‐00071, MOI‐RR‐00079, and MOI‐RR‐00083).

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