PROCAARE: Vitamin A, oral contraception and HIV infection--Kenya

[procaare@usa.healthnet.org]

Reference: Mostad, S.B., Overbaugh, J., DeVange, D.M., Welch, M.J.,
Chohan, B., Mandaliya, K., Nyange, P., Martin, Jr., H.L., Ndinya-Achola,
J., Bwayo, J.J., Kreiss, J.K. (1997).  Hormonal contraception, vitamin A
deficiency, and other risk factors for shedding of HIV-1 infected cells
from the cervix and vagina.  Lancet 350: 922-7.

This cross-sectional study enrolled 318 HIV-1-infected female patients at
an STD clinic in Mombasa, Kenya.  Median age was 28, and 70% were
commercial sex workers; mean CD4 count was 451/mm3. Vaginal and cervical
swabs were evaluated for the presence of HIV-1 using PCR amplification.
HIV-1 shedding was detected in 51% and 14% of endocervical and vaginal
swabs, respectively.   Cervical and vaginal HIV-1 shedding were
significantly associated with decreased CD4 counts.  Use of depot
medroxyprogesterone acetate (odds ratio 2.9, 95% CI 1.5-5.7),  low-dose
(3.8, 95% CI 1.4-9.9), and high-dose (odds ratio 12.3, CI 1.5-101) oral
contraceptive pills were correlated with cervical shedding of
HIV-1-infected cells (adjusted for CD4 count).  In addition, severe
vitamin A deficiency (serum <0.70 micromol/L) was associated with an odds
ratio of 12.9 for vaginal HIV-1 shedding; mild deficiency (1.05-1.39
micromol/L) was still associated with an increased odds ratio of 4.9.
Significant associations were also reported for HIV-1 shedding and both
gonococcal cervicitis  (odds ratio 3.1, CI 1.1-9.8), and vaginal
candidiasis (2.6, 1,2-5.4), while no correlations were observed for
Chlamydia and Trichomonas infection.

KEYWORDS: CLINICAL SCIENCE, HIV-1 SHEDDING, CERVICAL SHEDDING, VAGINAL
SHEDDING, VITAMIN A, ORAL CONTRACEPTIVE PILL, GONOCOCCAL CERVICITIS,
CANDIDIASIS, KENYA

From: Albert Shaw <ashaw@usa.healthnet.org>
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