Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania
Identifieur interne : 001D37 ( Pmc/Corpus ); précédent : 001D36; suivant : 001D38Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania
Auteurs : Deborah Watson-Jones ; Kathy Baisley ; Helen A. Weiss ; Clare Tanton ; John Changalucha ; Dean Everett ; Tobias Chirwa ; David Ross ; Tim Clayton ; Richard HayesSource :
- AIDS (London, England) [ 0269-9370 ] ; 2009.
Abstract
A randomized double-blind placebo-controlled trial (RCT) of HSV-2 suppressive therapy with acyclovir 400mg b.d. conducted among women in northwestern Tanzania reported a similar rate of HIV acquisition in both trial arms (Current Controlled Trials number ISRCTN35385041). Risk factors for HIV incidence were examined in the context of three-monthly follow-up visits offering both VCT and STI care.
Prospective cohort analysis of trial participants enrolled and followed for up to 30 months.
Risk factors for HIV acquisition were analysed using Cox regression.
Overall 821 HSV-2 seropositive, HIV seronegative women were randomized; 400 to acyclovir and 421 to placebo; 659 (80.3%) completed follow-up. HIV incidence was 4.27 per 100 person-years. There was no overall impact of acyclovir on HIV incidence (hazard ratio (HR)=1.01; 95%CI:0.61-1.66). HIV acquisition was independently associated with younger age at enrolment (age 16-19 vs 30-35: HR=4.02; 95%CI:1.67-9.68), alcohol consumption at enrolment (≥30 drinks/week vs.none: HR=4.39, 95%CI 1.70-11.33), having paid sex within the previous 3 months (HR=1.82, 95%CI:1.09-3.05), recent infection with gonorrhoea (HR=3.62, 95%CI:1.62-8.08) and injections in the previous 3 months (HR=3.45, 95%CI:1.62-7.34). There was some evidence of an association between HIV incidence and living in the recruitment community for less than 2 years (HR=1.75, 95%CI:0.98-3.10), and exposure to hormonal contraception (HR=1.60, 95%CI:0.93-2.76).
A high incidence of HIV was observed in this trial cohort, especially in young women. Interventions are needed to address the risk associated with alcohol use and to sustain control of other STIs.
Url:
DOI: 10.1097/QAD.0b013e32831ef523
PubMed: 19114859
PubMed Central: 3223401
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania</title><author><name sortKey="Watson Jones, Deborah" sort="Watson Jones, Deborah" uniqKey="Watson Jones D" first="Deborah" last="Watson-Jones">Deborah Watson-Jones</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A2">African Medical and Research Foundation (AMREF), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Baisley, Kathy" sort="Baisley, Kathy" uniqKey="Baisley K" first="Kathy" last="Baisley">Kathy Baisley</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Weiss, Helen A" sort="Weiss, Helen A" uniqKey="Weiss H" first="Helen A" last="Weiss">Helen A. Weiss</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author><author><name sortKey="Tanton, Clare" sort="Tanton, Clare" uniqKey="Tanton C" first="Clare" last="Tanton">Clare Tanton</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Changalucha, John" sort="Changalucha, John" uniqKey="Changalucha J" first="John" last="Changalucha">John Changalucha</name><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Everett, Dean" sort="Everett, Dean" uniqKey="Everett D" first="Dean" last="Everett">Dean Everett</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Chirwa, Tobias" sort="Chirwa, Tobias" uniqKey="Chirwa T" first="Tobias" last="Chirwa">Tobias Chirwa</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Ross, David" sort="Ross, David" uniqKey="Ross D" first="David" last="Ross">David Ross</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author><author><name sortKey="Clayton, Tim" sort="Clayton, Tim" uniqKey="Clayton T" first="Tim" last="Clayton">Tim Clayton</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author><author><name sortKey="Hayes, Richard" sort="Hayes, Richard" uniqKey="Hayes R" first="Richard" last="Hayes">Richard Hayes</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">19114859</idno><idno type="pmc">3223401</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223401</idno><idno type="RBID">PMC:3223401</idno><idno type="doi">10.1097/QAD.0b013e32831ef523</idno><date when="2009">2009</date><idno type="wicri:Area/Pmc/Corpus">001D37</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001D37</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania</title><author><name sortKey="Watson Jones, Deborah" sort="Watson Jones, Deborah" uniqKey="Watson Jones D" first="Deborah" last="Watson-Jones">Deborah Watson-Jones</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A2">African Medical and Research Foundation (AMREF), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Baisley, Kathy" sort="Baisley, Kathy" uniqKey="Baisley K" first="Kathy" last="Baisley">Kathy Baisley</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Weiss, Helen A" sort="Weiss, Helen A" uniqKey="Weiss H" first="Helen A" last="Weiss">Helen A. Weiss</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author><author><name sortKey="Tanton, Clare" sort="Tanton, Clare" uniqKey="Tanton C" first="Clare" last="Tanton">Clare Tanton</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Changalucha, John" sort="Changalucha, John" uniqKey="Changalucha J" first="John" last="Changalucha">John Changalucha</name><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Everett, Dean" sort="Everett, Dean" uniqKey="Everett D" first="Dean" last="Everett">Dean Everett</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Chirwa, Tobias" sort="Chirwa, Tobias" uniqKey="Chirwa T" first="Tobias" last="Chirwa">Tobias Chirwa</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation><affiliation><nlm:aff id="A3">National Institute for Medical Research (NIMR), Mwanza, Tanzania</nlm:aff></affiliation></author><author><name sortKey="Ross, David" sort="Ross, David" uniqKey="Ross D" first="David" last="Ross">David Ross</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author><author><name sortKey="Clayton, Tim" sort="Clayton, Tim" uniqKey="Clayton T" first="Tim" last="Clayton">Tim Clayton</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author><author><name sortKey="Hayes, Richard" sort="Hayes, Richard" uniqKey="Hayes R" first="Richard" last="Hayes">Richard Hayes</name><affiliation><nlm:aff id="A1">London School of Hygiene & Tropical Medicine, London, UK</nlm:aff></affiliation></author></analytic><series><title level="j">AIDS (London, England)</title><idno type="ISSN">0269-9370</idno><idno type="eISSN">1473-5571</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title><p id="P1">A randomized double-blind placebo-controlled trial (RCT) of HSV-2 suppressive therapy with acyclovir 400mg b.d. conducted among women in northwestern Tanzania reported a similar rate of HIV acquisition in both trial arms (Current Controlled Trials number ISRCTN35385041). Risk factors for HIV incidence were examined in the context of three-monthly follow-up visits offering both VCT and STI care.</p></sec><sec id="S2"><title>Design</title><p id="P2">Prospective cohort analysis of trial participants enrolled and followed for up to 30 months.</p></sec><sec id="S3"><title>Methods</title><p id="P3">Risk factors for HIV acquisition were analysed using Cox regression.</p></sec><sec id="S4"><title>Results</title><p id="P4">Overall 821 HSV-2 seropositive, HIV seronegative women were randomized; 400 to acyclovir and 421 to placebo; 659 (80.3%) completed follow-up. HIV incidence was 4.27 per 100 person-years. There was no overall impact of acyclovir on HIV incidence (hazard ratio (HR)=1.01; 95%CI:0.61-1.66). HIV acquisition was independently associated with younger age at enrolment (age 16-19 vs 30-35: HR=4.02; 95%CI:1.67-9.68), alcohol consumption at enrolment (≥30 drinks/week vs.none: HR=4.39, 95%CI 1.70-11.33), having paid sex within the previous 3 months (HR=1.82, 95%CI:1.09-3.05), recent infection with gonorrhoea (HR=3.62, 95%CI:1.62-8.08) and injections in the previous 3 months (HR=3.45, 95%CI:1.62-7.34). There was some evidence of an association between HIV incidence and living in the recruitment community for less than 2 years (HR=1.75, 95%CI:0.98-3.10), and exposure to hormonal contraception (HR=1.60, 95%CI:0.93-2.76).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">A high incidence of HIV was observed in this trial cohort, especially in young women. Interventions are needed to address the risk associated with alcohol use and to sustain control of other STIs.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">8710219</journal-id><journal-id journal-id-type="pubmed-jr-id">1493</journal-id><journal-id journal-id-type="nlm-ta">AIDS</journal-id><journal-id journal-id-type="iso-abbrev">AIDS</journal-id><journal-title-group><journal-title>AIDS (London, England)</journal-title></journal-title-group><issn pub-type="ppub">0269-9370</issn><issn pub-type="epub">1473-5571</issn></journal-meta><article-meta><article-id pub-id-type="pmid">19114859</article-id><article-id pub-id-type="pmc">3223401</article-id><article-id pub-id-type="doi">10.1097/QAD.0b013e32831ef523</article-id><article-id pub-id-type="manuscript">UKMS4586</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Risk factors for HIV incidence in women participating in an HSV suppressive treatment trial in Tanzania</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Watson-Jones</surname><given-names>Deborah</given-names></name><degrees>M.D., Ph.D</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A2">2</xref></contrib><contrib contrib-type="author"><name><surname>Baisley</surname><given-names>Kathy</given-names></name><degrees>M.Sc</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Weiss</surname><given-names>Helen A</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Tanton</surname><given-names>Clare</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Changalucha</surname><given-names>John</given-names></name><degrees>M.Sc</degrees><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Everett</surname><given-names>Dean</given-names></name><degrees>Ph.D</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Chirwa</surname><given-names>Tobias</given-names></name><degrees>Ph.D</degrees><xref ref-type="aff" rid="A1">1</xref><xref ref-type="aff" rid="A3">3</xref></contrib><contrib contrib-type="author"><name><surname>Ross</surname><given-names>David</given-names></name><degrees>M.D., Ph.D</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Clayton</surname><given-names>Tim</given-names></name><degrees>M.Sc</degrees><xref ref-type="aff" rid="A1">1</xref></contrib><contrib contrib-type="author"><name><surname>Hayes</surname><given-names>Richard</given-names></name><degrees>D.Sc</degrees><xref ref-type="aff" rid="A1">1</xref></contrib></contrib-group><aff id="A1"><label>1</label>London School of Hygiene & Tropical Medicine, London, UK</aff><aff id="A2"><label>2</label>African Medical and Research Foundation (AMREF), Mwanza, Tanzania</aff><aff id="A3"><label>3</label>National Institute for Medical Research (NIMR), Mwanza, Tanzania</aff><author-notes><corresp id="CR1">Corresponding author: Dr Deborah Watson-Jones, Department of Infectious & Tropical Diseases, Keppel Street, London, WC1E 7HT. <email>deborah.watson-jones@lshtm.ac.uk</email></corresp><fn id="FN3"><p id="P29">AUTHOR CONTRIBUTIONS</p><p id="P30">DWJ was principal investigator, supervised the trial and wrote the first draft of the paper. DWJ, RH, DR, TCl, and HW designed the study; KB and TCh were responsible for data management for the trial; KB and HW conducted the analysis; JC and DE supervised the laboratory work; CT supervised fieldwork; all authors commented on drafts of the manuscript and approved the final version; DWJ and RH act as guarantors for the results presented in the paper.</p></fn></author-notes><pub-date pub-type="nihms-submitted"><day>2</day><month>11</month><year>2011</year></pub-date><pub-date pub-type="ppub"><day>28</day><month>1</month><year>2009</year></pub-date><pub-date pub-type="pmc-release"><day>24</day><month>11</month><year>2011</year></pub-date><volume>23</volume><issue>3</issue><fpage>415</fpage><lpage>422</lpage><abstract><sec id="S1"><title>Objectives</title><p id="P1">A randomized double-blind placebo-controlled trial (RCT) of HSV-2 suppressive therapy with acyclovir 400mg b.d. conducted among women in northwestern Tanzania reported a similar rate of HIV acquisition in both trial arms (Current Controlled Trials number ISRCTN35385041). Risk factors for HIV incidence were examined in the context of three-monthly follow-up visits offering both VCT and STI care.</p></sec><sec id="S2"><title>Design</title><p id="P2">Prospective cohort analysis of trial participants enrolled and followed for up to 30 months.</p></sec><sec id="S3"><title>Methods</title><p id="P3">Risk factors for HIV acquisition were analysed using Cox regression.</p></sec><sec id="S4"><title>Results</title><p id="P4">Overall 821 HSV-2 seropositive, HIV seronegative women were randomized; 400 to acyclovir and 421 to placebo; 659 (80.3%) completed follow-up. HIV incidence was 4.27 per 100 person-years. There was no overall impact of acyclovir on HIV incidence (hazard ratio (HR)=1.01; 95%CI:0.61-1.66). HIV acquisition was independently associated with younger age at enrolment (age 16-19 vs 30-35: HR=4.02; 95%CI:1.67-9.68), alcohol consumption at enrolment (≥30 drinks/week vs.none: HR=4.39, 95%CI 1.70-11.33), having paid sex within the previous 3 months (HR=1.82, 95%CI:1.09-3.05), recent infection with gonorrhoea (HR=3.62, 95%CI:1.62-8.08) and injections in the previous 3 months (HR=3.45, 95%CI:1.62-7.34). There was some evidence of an association between HIV incidence and living in the recruitment community for less than 2 years (HR=1.75, 95%CI:0.98-3.10), and exposure to hormonal contraception (HR=1.60, 95%CI:0.93-2.76).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">A high incidence of HIV was observed in this trial cohort, especially in young women. Interventions are needed to address the risk associated with alcohol use and to sustain control of other STIs.</p></sec></abstract><kwd-group><kwd>HIV</kwd><kwd>incidence</kwd><kwd>risk factors</kwd><kwd>women</kwd><kwd>high risk</kwd><kwd>Tanzania</kwd><kwd>randomized controlled trial</kwd><kwd>HSV-2</kwd></kwd-group><funding-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source><award-id>066688 || WT</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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