Male Circumcision and Womenʼs Risk of Incident Chlamydial, Gonococcal, and Trichomonal Infections

BACKGROUND: Male circumcision (MC) decreases the risk of human immunodeficiency virus (HIV) acquisition in men. We explored associations between MC of the primary sex partner and women's risk of acquisition of chlamydial (Ct), gonococcal (GC), or trichomonal (Tv) infections. METHODS: We analyzed data from a prospective study on hormonal contraception and incident human immunodeficiency virus/sexually transmitted infection (STI) among women from Uganda, Zimbabwe, and Thailand. At enrollment and each follow-up visit, we collected endocervical swabs for polymerase chain reaction identification of Ct and GC; Tv was diagnosed by wet mount. Using Cox proportional hazards models, we compared time to STI acquisition for women according to their partner's MC status. RESULTS: Among 5925 women (2180 from Uganda, 2228 from Zimbabwe, and 1517 from Thailand), 18.6% reported a circumcised primary partner at baseline, 70.8% reported an uncircumcised partner, and 9.7% did not know their partner's circumcision status. During follow-up, 408, 305, and 362 participants had a first incident Ct, GC, or Tv infection, respectively. In multivariate analysis, after controlling for contraceptive method, age, age at coital debut, and country, the adjusted hazard ratio (HR) comparing women with circumcised partners with those with uncircumcised partners for Ct was 1.25 [95% confidence interval (CI) 0.96-1.63]; for GC, adjusted HR 0.99 (95% CI 0.74-1.31); for Tv, adjusted HR 1.05 (95% CI 0.80-1.36), and for the 3 STIs combined, adjusted HR 1.02 (95% CI 0.85-1.21). CONCLUSIONS: MC was not associated with women's risk of acquisition of Ct, GC, or Tv infection in this cohort

Higher placental anti-inflammatory IL-10 cytokine expression in HIV-1 infected women receiving longer zidovudine prophylaxis associated with nevirapine

Placental cytokine balance may be critical for the control of mother-to-child transmission (MTCT) of HIV. We assessed whether the type and duration of antiretrovirals used for prevention of HIV-1-MTCT modified the inflammatory cytokine profile. We investigated the levels of cytokine expression in the placentas of 61 HIV-1-infected women who received zidovudine (ZDV) plus single dose nevirapine (SD-NVP) or ZDV only for prevention of MTCT. Placentas of 38 HIV-1-uninfected women were included as controls. All placentas were obtained after vaginal delivery. Levels of mRNA and cytokine expression were quantified using real-time PCR and ELISA, respectively, in placental explants and 24-hour culture supernatants and analyzed in relation to the women's characteristics and the type and duration of antiretroviral prophylaxis. HIV-1-infected and uninfected women did not show any differences in the expression of placental cytokine secretion except for a trend toward lower TNF-10 mRNA levels in HIV-1-infected women. Within the HIV-1-infected group, women who were exposed to a long duration of ZDV (>72 days) or received SD-NVP less than 5h prior to delivery, more frequently expressed detectable levels of IL-10 in their placentas (32% versus 7% (p = 0.01) and 32% versus 5% (p = 0.02), respectively). No infant was found to be HIV-1-infected. Our results showed a normalization of the placental cytokine balance in HIV-1-infected women receiving antiretroviral prophylaxis. Furthermore, the type and duration of antiretroviral prophylaxis have an impact on the placental anti-inflammatory IL-10 expression level, which may contribute to controlling HIV replication at the placental level, thus reducing MTCT of HIV-1.Fil: Pornprasert, Sakorn. Chiang Mai University; TailandiaFil: Mary, Jean-Yves. Université Paris Diderot - Paris 7; FranciaFil: Faye, Albert. Institut National de la Santé et de la Recherche Médicale; FranciaFil: Leechanachai, Pannee. Chiang Mai University; TailandiaFil: Limtrakul, Aram. Health Promotion Center Region; TailandiaFil: Rugpao, Sungwal. Chiang Mai University; TailandiaFil: Sirivatanapa, Pannee. Chiang Mai University; TailandiaFil: Gomuthbutra, Vorapin. Nakornping Hospital; TailandiaFil: Matanasaravoot, Wanmanee. Lamphun Hospital; TailandiaFil: Le Coer, Sophie. Institut National d’Etudes Démographiques; FranciaFil: Lallemant, Marc. Centre National de la Recherche Scientifique. Institut de Recherche pour le Développement; FranciaFil: Barré-Sinoussi, Françoise. Instituto Pasteur; FranciaFil: Menu, Elisabeth. Instituto Pasteur; FranciaFil: Ngo Giang Huong, Nicole. Centre National de la Recherche Scientifique. Institut de Recherche pour le Développement; FranciaFil: Ayouba, Ahidjo. Instituto Pasteur; FranciaFil: Chailert, Sanupong. Chiang Mai University; Tailandia. Instituto Pasteur; FranciaFil: Chaouat, Gérard. Institut National de la Santé et de la Recherche Médicale; FranciaFil: Derrien, Muriel. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Dolcini, Guillermina Laura. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Veterinarias. Departamento de Sanidad Animal y Medicina Preventiva. Laboratorio de Virología; Argentina. Instituto Pasteur; Francia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; ArgentinaFil: Eteki, Nicole. Hôpital Central de Yaoundé. Maternité Principale; CamerúnFil: Kfutwah, Anfumbom Jude. Instituto Pasteur; FranciaFil: Kouo, Odette. Instituto Pasteur; FranciaFil: Lemen, Brigitte. Instituto Pasteur; FranciaFil: Abal, Facundo Juan Pablo. Instituto Pasteur; FranciaFil: Nerrienet, Eric. Instituto Pasteur; FranciaFil: Njinku, Bernadette. Instituto Pasteur; FranciaFil: Scarlatti, Gabriella. Suan Dok Hospital; TailandiaFil: Tejiokem, Mathurin. Centre Pasteur du Cameroun; CamerúnFil: Téné, Gilbert. No especifíca

Hormonal contraception and the risk of HIV acquisition

BACKGROUND: Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. OBJECTIVE: To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. METHODS: This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18-35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases). RESULTS: HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69-1.42] nor DMPA (HR, 1.25; 95% CI, 0.89-1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39-5.82) and DMPA (HR, 3.97; 95% CI, 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. CONCLUSIONS: No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this findin