Female genital schistosomiasis and HIV-1 incidence in Zambian women: a retrospective cohort study

Sturt, A.S.; Webb, E.L.; Phiri, C.R.; Mudenda, M.; Mapani, J.; Kosloff, B.; Cheeba, M.; Shanaube, K.; Bwalya, J.; Kjetland, E.F.; Francis, S.C.; Corstjens, P.L.A.M.; Dam, G.J. van; Lieshout, L. van; Hansingo, I.; Ayles, H.; Hayes, R.J.; Bustinduy, A.L.

doi:doi:10.1093/ofid/ofab349

Background. Female genital schistosomiasis (FGS) has been associated with prevalent HIV-1. We estimated the incidence of HIV-1 infection in Zambian women with and without FGS.Methods. Women (aged 18-31, nonpregnant, sexually active) were invited to participate in this study in January-August 2018 at the final follow-up of the HPTN 071 (PopART) Population Cohort. HIV-1-negative participants at enrollment (n = 492) were included in this analysis, with testing to confirm incident HIV-1 performed in HPTN 071 (PopART). The association of incident HIV-1 infection with FGS (Schistosoma DNA detected by polymerase chain reaction [PCR] in any genital specimen) was assessed with exact Poisson regression.Results. Incident HIV-1 infections were observed in 4.1% (20/492) of participants. Women with FGS were twice as likely to seroconvert as women without FGS but with no statistical evidence for a difference (adjusted rate ratio, 2.16; 95% CI, 0.21-12.30; P = .33). Exploratory analysis suggested...Show moreBackground. Female genital schistosomiasis (FGS) has been associated with prevalent HIV-1. We estimated the incidence of HIV-1 infection in Zambian women with and without FGS.Methods. Women (aged 18-31, nonpregnant, sexually active) were invited to participate in this study in January-August 2018 at the final follow-up of the HPTN 071 (PopART) Population Cohort. HIV-1-negative participants at enrollment (n = 492) were included in this analysis, with testing to confirm incident HIV-1 performed in HPTN 071 (PopART). The association of incident HIV-1 infection with FGS (Schistosoma DNA detected by polymerase chain reaction [PCR] in any genital specimen) was assessed with exact Poisson regression.Results. Incident HIV-1 infections were observed in 4.1% (20/492) of participants. Women with FGS were twice as likely to seroconvert as women without FGS but with no statistical evidence for a difference (adjusted rate ratio, 2.16; 95% CI, 0.21-12.30; P = .33). Exploratory analysis suggested an association with HIV-1 acquisition among women with >= 2 positive genital PCR specimens (rate ratio, 6.02; 95% CI, 0.58-34.96; P = .13).Conclusions. Despite higher HIV seroconversion rates in women with FGS, there was no statistical evidence of association, possibly due to low power. Further longitudinal studies should investigate this association in a setting with higher schistosomiasis endemicity.Show less

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Female genital schistosomiasis and HIV-1 incidence in Zambian women: a retrospective cohort study