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Bacterial vaginosis, intravaginal practices and HIV genital shedding: implications for HIV transmission and women’s health Maria L Alcaide M.D. Associate.

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Presentation on theme: "Bacterial vaginosis, intravaginal practices and HIV genital shedding: implications for HIV transmission and women’s health Maria L Alcaide M.D. Associate."— Presentation transcript:

1 Bacterial vaginosis, intravaginal practices and HIV genital shedding: implications for HIV transmission and women’s health Maria L Alcaide M.D. Associate Professor of Clinical Medicine University of Miami Miller School of Medicine

2 Intravaginal practices (IVP) Background Bacterial vaginosis (BV) HIV infection IVP, BV and HIV are very prevalent in Zambia This study evaluates the relationship between IVP, BV and HIV lower genital shedding as a first step to understand how IVP and BV may increase HIV transmission OB/GYN complications Alcaide, AIDS and Behav. 2013 Farquar, AIDS 2010 Hilber PloS one 2010 Low, PloS medicine 2011 Methods Study site: Community Health Center in urban Lusaka Participants: 128 HIV infected women on ART, engaging in IVP IVP assessment: Questionnaires using ACASI BV: Nugent criteria using Gram stain examination Lower genital tract HIV shedding: CVL HIV-1 RNA

3 Risk factors associated with BV and HIV shedding

4 Conclusions This is the first study to evaluate the relationship between intravaginal practices (IVP), bacterial vaginosis (BV) and HIV lower genital shedding in HIV infected women receiving antiretroviral therapy. Despite high rates of IVP and BV, plasma viremia is the primary factor associated with HIV lower genital shedding. This supports early initiation of antiretroviral treatment as an HIV prevention tool. Given the strong association with frequent IVP and BV, IVP interventions to decrease BV by intervening in IVP should be essential components of women’s health programs. Multivariable analysis

5 Acknowledgments Miami Deborah Jones Margaret Fischl Savita Pahwa Mario Stevenson Zambia Maureen Chisembele Emeria Malupande Chileshe Mwanba Spear and Shield team Study participants R01HD058481-02S1 K23HD074489

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