Determinants of symptomatic vulvovaginal candidiasis among human immunodeficiency virus type 1 infected women in rural KwaZulu-Natal, South Africa

Infect Dis Obstet Gynecol. 2014:2014:387070. doi: 10.1155/2014/387070. Epub 2014 Apr 9.

Abstract

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/mm(3) (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/mm(3) and plasma HIV loads ≥10 000 copies/mL were significantly associated with VVC.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • CD4 Lymphocyte Count
  • Candidiasis, Vulvovaginal / epidemiology
  • Candidiasis, Vulvovaginal / virology*
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / microbiology*
  • HIV Infections / virology
  • Humans
  • Middle Aged
  • Retrospective Studies
  • Rural Population / statistics & numerical data
  • South Africa / epidemiology
  • Viral Load
  • Young Adult