Advertisement
Research Article

Bacterial Vaginosis Associated with Increased Risk of Female-to-Male HIV-1 Transmission: A Prospective Cohort Analysis among African Couples

  • Craig R. Cohen mail,

    ccohen@globalhealth.ucsf.edu

    Affiliations: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, United States of America, Women's Health & Empowerment Center of Expertise, University of California Global Health Institute, San Francisco, United States of America

    X
  • Jairam R. Lingappa,

    Affiliations: Department of Global Health, University of Washington, Seattle, Washington, United States of America, Department of Medicine, University of Washington, Seattle, Washington, United States of America, Department of Pediatrics University of Washington, University of Washington, Seattle, Washington, United States of America

    X
  • Jared M. Baeten,

    Affiliations: Department of Global Health, University of Washington, Seattle, Washington, United States of America, Department of Medicine, University of Washington, Seattle, Washington, United States of America, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America

    X
  • Musa O. Ngayo,

    Affiliation: Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya

    X
  • Carol A. Spiegel,

    Affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, United States of America

    X
  • Ting Hong,

    Affiliation: Department of Global Health, University of Washington, Seattle, Washington, United States of America

    X
  • Deborah Donnell,

    Affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America

    X
  • Connie Celum,

    Affiliations: Department of Global Health, University of Washington, Seattle, Washington, United States of America, Department of Medicine, University of Washington, Seattle, Washington, United States of America, Department of Epidemiology, University of Washington, Seattle, Washington, United States of America

    X
  • Saidi Kapiga,

    Affiliation: Department of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom

    X
  • Sinead Delany,

    Affiliation: Wits Reproductive Health & HIV Institute, University of Witwatersrand, Johannesburg, South Africa

    X
  • Elizabeth A. Bukusi

    Affiliations: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, United States of America, Department of Global Health, University of Washington, Seattle, Washington, United States of America, Department of Pediatrics University of Washington, University of Washington, Seattle, Washington, United States of America, Center for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya

    X
  • Published: June 26, 2012
  • DOI: 10.1371/journal.pmed.1001251

Reader Comments (1)

Post a new comment on this article

Vitamin D could reduce the risk of bacterial vaginosis, HIV-1, and female-to-male transmission of HIV-1

Posted by wbgrant on 05 Jul 2012 at 16:39 GMT

The paper by Cohen et al. [1] reports an association between bacterial vaginosis (BV) and female-to-male transmission of HIV-1. It was suggested that normalization of vaginal flora in HIV-1 infected women could reduce transmission. However, it was noted that no study of treatment of BV has yet reduced transmission rates.

A factor not considered in the paper was the role of vitamin D in reducing both BV and risk of HIV. Vitamin D strengthens the innate immune system to fight both bacterial and viral infections [2]. A recent study found “Vitamin D deficiency was independently associated with BV among HIV-infected women (AOR 3.12, 95% CI 1.16-8.38) but not among HIV-uninfected women.” [3]. Vitamin D also reduces risk of HIV-1 [4]

A study in Africa found “a low maternal vitamin D level (<32 ng/mL) was associated with a 50% higher risk (95% confidence interval [CI], 2%-120%) of mother-to-child transmission (MTCT) of HIV at 6 weeks, a 2-fold higher risk of MTCT of HIV through breast-feeding among children who were HIV uninfected at 6 weeks (95% CI, 1.08-3.82), and a 46% higher overall risk of HIV infection (95% CI, 11%-91%).” [5]. A subsequent study in Australia found an increased risk of HIV transmission from mother to child related to vitamin D deficiency [6].

Thus, raising serum 25-hydroxyvitamin D concentrations to above 30-40 ng/ml would likely reduce both risk of BV and HIV as well as transmission of HIV to sex partners and offspring.

References
1. Cohen CR, Lingappa JR, Baeten JM, Ngayo MO, Spiegel CA, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: A prospective cohort analysis among African couples. PLoS Med. 2012 Jun;9(6):e1001251.
2. Gombart AF. The vitamin D-antimicrobial peptide pathway and its role in protection against infection. Future Microbiol. 2009 Nov;4:1151-65.
3. French AL, Adeyemi OM, Agniel DM, Evans CT, Yin MT, et al. The association of HIV status with bacterial vaginosis and vitamin D in the United States. J Womens Health (Larchmt). 2011 Oct;20(10):1497-503.
4. Campbell GR, Spector SA. Vitamin D inhibits human immunodeficiency virus type 1 and Mycobacterium tuberculosis infection in macrophages through the induction of autophagy. PLoS Pathog. 2012 May;8(5):e1002689.
5. Mehta S, Hunter DJ, Mugusi FM, Spiegelman D, Manji KP, et al. Perinatal outcomes, including mother-to-child transmission of HIV, and child mortality and their association with maternal vitamin D status in Tanzania. J Infect Dis. 2009 Oct 1;200(7):1022-30.
6. Barrett H, McElduff A. Vitamin D and pregnancy: An old problem revisited. Best Pract Res Clin Endocrinol Metab. 2010 Aug;24(4):527-39.

Competing interests declared: I receive funding from the UV Foundation (McLean, VA), Bio-Tech Pharmacal (Fayetteville, AR), the Vitamin D Council (San Luis Obispo, CA), the Vitamin D Society (Canada), and the Sunlight Research Forum (Veldhoven).