Pregnancy in HIV-Positive Patients: Effects on Vaginal Flora

Vallone, Cristina; Rigon, Giuliano; Lucantoni, V.; Putignani, Lorenza; Signore, Fabrizio

doi:10.1155/2012/287849

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…The depletion of lactobacilli may limit the production of hydrogen peroxide. Vallone et al postulated that low vaginal pH inhibits CD4 lymphocyte activation and reduces HIV target cells in the vagina, while elevated vaginal pH may enhance HIV adherence to vaginal eukaryotic cells [ 25 ]. In this present study, although BV was prevalent among both HIV positive and HIV negative, there was a significant association between BV and higher expression of HIV RNA in the plasma of HIV-infected women.…”

Section: Discussionmentioning

confidence: 99%

Determinants of Symptomatic Vulvovaginal Candidiasis among Human Immunodeficiency Virus Type 1 Infected Women in Rural KwaZulu-Natal, South Africa

Apalata

Carr

Sturm

et al. 2014

Infectious Diseases in Obstetrics and Gynecology

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Introduction. We sought to determine the association between HIV-induced immunosuppression, virologic correlates, and vulvovaginal candidiasis (VVC). Methods. This is a retrospective cohort study, where HIV infected and uninfected women were studied with VVC being the primary outcome. Ninety-seven HIV-infected and 101 HIV-uninfected women were enrolled between June and December 2011. Cases of VVC were confirmed. HIV RNA load was determined by RT-PCR and CD4 counts were obtained from medical records. Results. Fifty-two of 97 (53.6%) HIV-infected and 38/101 (37.6%) HIV-uninfected women were diagnosed with VVC (P = 0.032). The relative risk for VVC amongst HIV-infected patients was 1.53 (95% CI: 1.04–2 P = 0.024). Cases of VVC increased at CD4+ T cell count below 200 cells/mm3 (P < 0.0001) and plasma HIV RNA load above 10 000 copies/mL (P < 0.0001). VVC was associated with increased genital shedding of HIV (P = 0.002), and there was a linear correlation between plasma HIV load and genital HIV shedding (r = 0.540; R 2 = 0.292; P < 0.0001). Women on HAART were 4-fold less likely (P = 0.029) to develop VVC. Conclusion. CD4 counts below 200 cells/mm3 and plasma HIV loads ≥10 000 copies/mL were significantly associated with VVC.

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Section: Discussionmentioning

confidence: 99%

Determinants of Symptomatic Vulvovaginal Candidiasis among Human Immunodeficiency Virus Type 1 Infected Women in Rural KwaZulu-Natal, South Africa

Apalata

Carr

Sturm

et al. 2014

Infectious Diseases in Obstetrics and Gynecology

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“…Although we matched cases and controls for potentially confounding factors, we were unable to adjust for HIV infection and hepatitis. There might be an increased prevalence of these infections among women with an abnormal vaginal flora, but it remains unclear whether this difference is related to the infection, the socioeconomic deprivation, the immunodeficiency, or to other, unknown factors [ 37 , 38 ]. Moreover, the increased susceptibility for vaginal infections in OMT women might also be induced by a frequent change of sexual partners, high sexual activity, underlying diseases, or co-abuse of other drugs that we were unable to adjust for [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the vaginal flora in pregnant women receiving opioid maintenance therapy: a matched case-control study

Farr

Kiss

Hagmann

et al. 2016

BMC Pregnancy Childbirth

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BackgroundVaginal infections are a risk factor for preterm delivery. In this study, we sought to evaluate the vaginal flora of pregnant women receiving opioid maintenance therapy (OMT) in comparison to non-dependent, non-maintained controls.MethodsA total of 3763 women with singleton pregnancies who underwent routine screening for asymptomatic vaginal infections between 10 + 0 and 16 + 0 gestational weeks were examined. Vaginal smears were Gram-stained, and microscopically evaluated for bacterial vaginosis, candidiasis, and trichomoniasis. In a retrospective manner, data of 132 women receiving OMT (cases) were matched for age, ethnicity, parity, education, previous preterm delivery, and smoking status to the data of 3631 controls. The vaginal flora at antenatal screening served as the primary outcome measure. Secondary outcome measures were gestational age and birth weight.ResultsIn the OMT group, 62/132 (47 %) pregnant women received methadone, 39/132 (29.5 %) buprenorphine, and 31/132 (23.5 %) slow-release oral morphine. Normal or intermediate flora was found in 72/132 OMT women (54.5 %) and 2865/3631 controls [78.9 %; OR 0.49 (95 % CI, 0.33–0.71); p < 0.001]. Candidiasis occurred more frequently in OMT women than in controls [OR 2.11 (95 % CI, 1.26–3.27); p < 0.001]. Findings were inconclusive regarding bacterial vaginosis (± candidiasis) and trichomoniasis. Compared to infants of the control group, those of women with OMT had a lower mean birth weight [MD −165.3 g (95 % CI, −283.6 to −46.9); p = 0.006].ConclusionsPregnant women with OMT are at risk for asymptomatic vaginal infections. As recurrent candidiasis is associated with preterm delivery, the vulnerability of this patient population should lead to consequent antenatal infection screening at early gestation.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1003-z) contains supplementary material, which is available to authorized users.

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“…68,69 Likewise, HIV seroprevalence significantly increases in pregnant women with severe BV compared with women with lactobacilli-dominated VMB. 70,71 A prospective cohort study showed that HIV-1-seronegative women demonstrated different risks for HIV acquisition based on the presence or absence of vaginal lactobacilli. This was proposed to be based on differences in the proportion of non-H 2 O 2 -producing lactobacilli and H 2 O 2producing lactobacilli, with the latter being more beneficial in HIV prevention.…”

Section: The Vaginal Microbiome and Stismentioning

confidence: 99%

“…Cross-sectional studies have revealed that HIV is frequently correlated with BV and independent of behavioral variables associated with BV and HIV, whereas HIV infection is lower in women with vaginal eubiosis 68,69 . Likewise, HIV seroprevalence significantly increases in pregnant women with severe BV compared with women with lactobacilli-dominated VMB 70,71 . A prospective cohort study showed that HIV-1–seronegative women demonstrated different risks for HIV acquisition based on the presence or absence of vaginal lactobacilli.…”

Section: The Vaginal Microbiome and Stismentioning

confidence: 99%

The Vaginal Microbiome: III. The Vaginal Microbiome in Various Urogenital Disorders

Seta

Lonnée-Hoffmann

Campisciano

et al. 2022

J Low Genit Tract Dis

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This series of articles, titled The Vaginal Microbiome (VMB), written on behalf of the International Society for the Study of Vulvovaginal Disease, aims to summarize the recent findings and understanding of the vaginal bacterial microbiota, mainly regarding areas relevant to clinicians specializing in vulvovaginal disorders.Materials and Methods: A search of PubMed database was performed, using the search terms "vaginal microbiome" with "Candida," "vaginitis," "urinary microbiome," "recurrent urinary tract infections," "sexually transmitted infections," "human immunodeficiency virus," "human papillomavirus," "nonspecific vaginitis," "vulvodynia," and "vulvovaginal symptoms." Full article texts were reviewed. Reference lists were screened for additional articles. The third article in this series describes VMB in various urogenital disorders.Results: Variable patterns of the VMB are found in patients with vulvovaginal candidiasis, challenging the idea of a protective role of lactobacilli. Highly similar strains of health-associated commensal bacteria are shared in both the bladder and vagina of the same individual and may provide protection against urinary tract infections. Dysbiotic VMB increases the risk of urinary tract infection. Loss of vaginal lactic acid-producing bacteria combined with elevated pH, increase the risk for sexually transmitted infections, although the exact protective mechanisms of the VMB against sexually transmitted infections are still unknown. Conclusions:The VMB may constitute a biological barrier to pathogenic microorganisms. When the predominance of lactobacilli community is disrupted, there is an increased risk for the acquisition of various vaginal pathogents. Longitudinal studies are needed to describe the association between the host, bacterial, and fungal components of the VMB.

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Pregnancy in HIV-Positive Patients: Effects on Vaginal Flora

Cited by 5 publications

References 19 publications

Determinants of Symptomatic Vulvovaginal Candidiasis among Human Immunodeficiency Virus Type 1 Infected Women in Rural KwaZulu-Natal, South Africa

Determinants of Symptomatic Vulvovaginal Candidiasis among Human Immunodeficiency Virus Type 1 Infected Women in Rural KwaZulu-Natal, South Africa

Evaluation of the vaginal flora in pregnant women receiving opioid maintenance therapy: a matched case-control study

The Vaginal Microbiome: III. The Vaginal Microbiome in Various Urogenital Disorders

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