Co-occurrence of Trichomonas vaginalis and bacterial vaginosis and vaginal shedding of HIV-1 RNA

Sex Transm Dis. 2014 Mar;41(3):173-9. doi: 10.1097/OLQ.0000000000000089.


Background: Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are independently associated with increased risk of vaginal shedding in HIV-positive women. Because these 2 conditions commonly co-occur, this study was undertaken to examine the association between TV/BV co-occurrence and vaginal shedding of HIV-1 RNA.

Methods: HIV-positive women attending outpatient HIV clinics in 3 urban US cities underwent a clinical examination; were screened for TV, BV, Neisseria gonorrhoeae, Chlamydia trachomatis, and vulvovaginal candidiasis; and completed a behavioral survey. Women shedding HIV-1 RNA vaginally (≥50 copies/mL) were compared with women who had an undetectable (<50 copies/mL) vaginal viral load to determine if women who were TV positive and BV positive or had co-occurrence of TV/BV had higher odds of shedding vaginally when compared with women who did not have these conditions.

Results: In this sample of 373 HIV-positive women, 43.1% (n = 161) had co-occurrence of TV/BV and 33.2% (n = 124) were shedding HIV-1 RNA vaginally. The odds of shedding HIV vaginally in the presence of TV alone or BV alone and when TV/BV co-occurred were 4.07 (95% confidence interval [CI], 1.78-9.37), 5.65 (95% CI, 2.64-12.01), and 18.63 (95% CI, 6.71-51.72), respectively, when compared with women with no diagnosis of TV or BV, and after adjusting for age, antiretroviral therapy status, and plasma viral load.

Conclusions: T. vaginalis and BV were independently and synergistically related to vaginal shedding of HIV-1 RNA. Screening and prompt treatment of these 2 conditions among HIV-positive women are important not only clinically but for HIV prevention, as well.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • CD4 Lymphocyte Count
  • Candidiasis, Vulvovaginal / complications
  • Candidiasis, Vulvovaginal / epidemiology
  • Candidiasis, Vulvovaginal / microbiology*
  • Coinfection
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / microbiology*
  • HIV Infections / prevention & control
  • HIV-1 / isolation & purification*
  • Humans
  • Prevalence
  • RNA, Viral / metabolism*
  • Sexual Behavior
  • Trichomonas Vaginitis / complications
  • Trichomonas Vaginitis / epidemiology
  • Trichomonas Vaginitis / microbiology*
  • Trichomonas vaginalis / isolation & purification*
  • United States
  • Urban Population
  • Vagina / microbiology
  • Vaginal Discharge / microbiology
  • Vaginosis, Bacterial / complications
  • Vaginosis, Bacterial / epidemiology
  • Vaginosis, Bacterial / microbiology*
  • Viral Load
  • Virus Shedding


  • RNA, Viral