Longitudinal analysis of bacterial vaginosis: findings from the HIV epidemiology research study

Obstet Gynecol. 2001 Oct;98(4):656-63. doi: 10.1016/s0029-7844(01)01525-3.


Objective: To determine the natural history of bacterial vaginosis in women with or at risk for human immunodeficiency virus (HIV).

Methods: A cohort of 854 HIV-infected women and 434 HIV-uninfected women from four US sites was followed prospectively with gynecologic exams every 6 months over a 5-year period. The prevalence, incidence, persistence, and severity of bacterial vaginosis, which was defined using a Gram-staining scoring system, were calculated using generalized estimating equation methods.

Results: In adjusted analyses, HIV-infected women had a higher prevalence of bacterial vaginosis than HIV-uninfected women (adjusted odds ratio [OR] 1.29; 95% confidence interval [CI] 1.08, 1.55). Although HIV-infected women were not more likely to have incident infections, they were more likely to have persistence of their infections (adjusted OR 1.49; 95% CI 1.18, 1.89). Similarly, immunocompromised women (CD4+ cell count less than 200 cells/microL) were more likely than HIV-infected women with higher CD4+ cell counts (more than 500 cells/microL) to have prevalent (adjusted OR 1.29; 95% CI 1.03, 1.60) and persistent (adjusted OR 1.38; 95% CI 1.01, 1.91) bacterial vaginosis infections, but not more likely to have incident infections. Immunocompromised women had more severe bacterial vaginosis by both clinical criteria (adjusted OR 1.40; 95% CI 1.08, 1.82) and by Gram-staining criteria (adjusted OR 1.50; 95% CI 1.12, 2.00).

Conclusions: Bacterial vaginosis is more prevalent and persistent among HIV-infected women, particularly among those who are immunocompromised. Immunocompromised women are more likely than HIV-infected women with higher CD4+ cell counts to have severe bacterial vaginosis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • AIDS-Related Opportunistic Infections / classification
  • AIDS-Related Opportunistic Infections / epidemiology*
  • Adolescent
  • Adult
  • Female
  • HIV Infections / complications
  • HIV Infections / epidemiology
  • HIV Seronegativity
  • Humans
  • Incidence
  • Longitudinal Studies
  • Middle Aged
  • Odds Ratio
  • Prevalence
  • Risk Factors
  • Severity of Illness Index
  • United States / epidemiology
  • Vaginosis, Bacterial / classification
  • Vaginosis, Bacterial / complications
  • Vaginosis, Bacterial / epidemiology*