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Khatija
Ahmed, Nazira Cassim, Stephen Eghan,
Lydia Altini,
Smruti Patel, Gita
Ramjee, and Thesla Palanee. "The prevalence of STIs in HIV-positive
versus HIV-negative women screened during the Phase 3 Carraguard®
clinical trial, at three sites in South Africa."
ABSTRACT
Background
Sexually transmitted infections (STIs) are endemic in many under-resourced settings and are a contributing cause of HIV transmission
globally. A Phase 3 clinical trial of Carraguard®, the Population
Council’s lead microbicide candidate, is being conducted at three
sites in South Africa. Potential participants are tested for STIs and screened for HIV as part of
the eligibility
criteria. Our objective is to assess the prevalence of STIs in HIV-negative as compared to HIV-positive women across the
three sites in
South Africa, the Setshaba Research Centre (SRC; Soshanguve,
Pretoria), the Empilisweni Centre for Wellness Studies, (ECWS; Gugulethu,
Cape Town), and the Medical Research Council (MRC; Isipingo, Durban).
Method
A total of 9,198 women were screened from the period March 2004–June 2006. All participants were counseled and screened for HIV
using two rapid tests, the Determine™
(Abbott) and OraQuick® (UCB) test kits. Blood was drawn for syphilis.
Speculum examinations were performed and specimens collected for Chlamydia trachomatis
(CT), Neisseria gonorrhoeae (NG), and Trichomonas
vaginalis (TV). Data were analyzed using SAS software calculating the
chi
square and odds ratio to determine the association between HIV and STIs
Results
The prevalence of HIV was 17.7 percent, 24.3 percent, and 42.8
percent at ECWS, SRC,
and MRC, respectively. Table 1 shows the prevalence of STIs among the HIV-positive and
-negative women
Table 1: Prevalence of STIs in the HIV-positive and -negative
women
| |
EHC |
SRC |
MRC |
TOTAL |
| |
HIV |
HIV |
HIV |
HIV |
| % |
-pos |
-neg |
-pos |
-neg |
-pos |
-neg |
-pos |
-neg |
| NG |
8.2 |
3.4 |
5.9 |
2.8 |
8.2 |
2.9 |
7.5 |
3.0 |
| CT |
14.5 |
11.2 |
12.8 |
9.3 |
11.2 |
8.1 |
12.4 |
9.7 |
| TV |
25.4 |
16.4 |
21.9 |
11.5 |
19.3 |
10.3 |
21.4 |
13.0 |
| Syphilis |
8.8 |
5.4 |
5.9 |
5.0 |
4.5 |
2.6 |
5.8 |
4.6 |
| Total STIs |
14.2 |
9.1 |
11.6 |
7.2 |
10.8 |
5.9 |
11.8 |
7.6 |
The overall relative risk of a concurrent STI in HIV-positive
women is 1.6.The relative risk of the following infections in HIV-positive as compared to HIV-negative women are: gonorrhea 2.5
times, chlamydia 1.3 times, trichomoniasis 1.8 times, and syphilis
1.3 times greater. There were slight variations in the odds ratios
across the three sites; however, they were all clinically significant.
Conclusion
The prevalence of STIs is much higher in those who are HIV-positive,
and the relative risk of having an STI is higher. In addition STIs
are a serious predisposing factor for HIV transmission. Therefore
aggressive treatment of STIs is important in decreasing HIV
transmission. It remains important to educate women on sexual
health, and the development of a microbicide will empower women to
protect themselves against HIV and some STIs.
3rd South African AIDS Conference Web site
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