Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
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- The influence and benefits of controlling for inflammation on plasma ferritin and hemoglobin responses following a multi-micronutrient supplement in apparently healthy, HIV+ Kenyan adults.
Document Number: 324667 Dihydrofolate reductase I164L mutations in Plasmodium falciparum isolates: Clinical outcome of 14 Kenyan adults infected with parasites harbouring the I164L mutation. Author: Hamel MJ; Poe A; Bloland P; McCollum A; Zhou Z Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2008 Apr Abstract: Recently, Plasmodium falciparum bearing dihydrofolate reductase (DHFR) I164L was isolated from Africa. Quadruple mutations containing I164L confer high-level resistance to antifolate antimalarials. We prospectively measured the effect of co-trimoxazole (CTX) prophylaxis on P. falciparum antifolate resistance development among HIV-infected persons. HIV-positive patients with CD4 cell count less than 350 cells/microl (n = 692) received CTX; HIV-positive patients with CD4 cell count greater than or equal to 350 cells/microl (n = 336) and HIV-negative patients (n = 132) received multivitamins. Malaria microscopy-positive samples (n = 413) and selected microscopy-negative/PCR-positive samples (n = 76) were analysed for DHFR mutations at baseline and during six months follow up. We identified I164L in 14 patients. Seven were malaria microscopy-positive: two failed sulfadoxine-pyrimethamine (SP). Among seven microscopynegative/ PCR-positive patients, none developed patent infections with I164L. I164L wasnot associated with high-level SP resistance or poor outcome among adults living where malaria is highly endemic. Surveillance to monitor spread of I164L is critical, especially among children and pregnant women, who are potentially a source for I164L amplification. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | ADULTS | HIV POSITIVE PERSONS | PARASITES | MALARIA | ANTIMALARIAL DRUGS | DRUG RESISTANCE | VITAMINS AND MINERALS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | BIOLOGY | PARASITIC DISEASES | TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | PHYSIOLOGY Document Number: 325272 HIV-neutralizing immunoglobulin A and HIV-specific proliferation are independently associated with reduced HIV acquisition in Kenyan sex workers. Author: Hirbod T; Kaul R; Reichard C; Kimani J; Ngugi. DP: 2008 Mar 30 Abstract: HIV-neutralizing immunoglobulin A (IgA) and HIV-specific cellular immunity have been described in highly exposed, persistently seronegative (HEPS) individuals, but well controlled studies have not been performed. We performed a prospective, nested case-control study to examine the association of genital IgA and systemic cellular immune responses with subsequent HIV acquisition in high-risk Kenyan female sex workers (FSWs). A randomized trial of monthly antibiotic prophylaxis to prevent sexually transmitted disease/HIV infection was performed from 1998 to 2002 in HIV-uninfected Kenyan of genital IgA to neutralize primary HIV isolates as well as systemic HIV-specific cellular IFNy-modified enzyme-linked immunospot and proliferativeresponses. The study cohort comprised 113 FSWs: 24 cases who acquired HIV and 89 matched controls. Genital HIV-neutralizing IgA was associated with reduced HIV acquisition (P = 0.003), as was HIV-specific proliferation (P = 0.002), and these associations were additive. HIV-specific IFNg production did not differ between case and control groups. In multivariable analysis, HIV-neutralizing IgA and HIV-specific proliferation each remained independently associated with lack of HIV acquisition. Genital herpes (HSV2) FSWs. After the completion of trial, FSWs who had acquired HIV (cases) were matched 1 : 4 with persistently uninfected controls based on study arm, duration of HIV-seronegative follow-up, and time of cohort enrolment. Blinded investigators assayed the ability at enrolment was associated with increased HIV risk and with reduced detection of HIV-neutralizing IgA. Genital HIV-neutralizing IgA and systemic HIV-specific proliferative responses, assayed by blinded investigators, were prospectively associated with HIV nonacquisition. The induction of these immune responses may be an important goal for HIV vaccines. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX WORKERS | HIV | BLOOD | LABORATORY PROCEDURES | EXPOSURE | AUTOIMMUNE RESPONSE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HEMIC SYSTEM | PHYSIOLOGY | BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | RISK FACTORS | ANTIBODIES | IMMUNOLOGIC FACTORS | IMMUNITY | IMMUNE SYSTEM Document Number: 325533 The impact of maternal HIV status on infant feeding patterns in Nakuru, Kenya. Author: Kamau-Mbuthia E; Elmadfa I; Mwonya R Source: Journal of Human Lactation Abstract: The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P less than .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (greater than mean birth weight, P less than .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. (author's) The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P less than .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (greater than mean birth weight, P less than .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. (author's) The aim of the study was to assess the impact of maternal HIV status on infant feeding patterns. Two hundred eighty mothers (205 HIV uninfected, 75 infected) and their infants were recruited from the Provincial General Hospital, Nakuru, Kenya, from delivery and were followed for 14 weeks. From the feeding patterns, HIV-infected mothers were more likely to exclusively breastfeed in week 1 than HIV-uninfected mothers (71.7% vs 56.3%, P = .001), but there were no differences by week 14 (9.8% vs 4.8% P = .212). Mixed feeding increased for both groups from weeks 1 to 14. In multivariate logistic regression analysis, maternal age (younger mothers, P less than .05) was associated with exclusive breastfeeding in the 6th week and infant birth weight (greater than mean birth weight, P less than .05) in the 10th week. The results indicate a need to reassess adherence to infant feeding recommendations irrespective of maternal HIV status and also the infant feeding counseling process in the hospital. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | INTERVIEWS | QUESTIONNAIRES | MOTHERS | INFANT | HIV | INFANT NUTRITION | BREASTFEEDING, EXCLUSIVE | SUPPLEMENTARY FEEDING | SOCIOECONOMIC STATUS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DATA COLLECTION | RESEARCH METHODOLOGY | PARENTS | FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | NUTRITION | HEALTH | BREASTFEEDING | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS Document Number: 325533 Human immunodeficiency virus (HIV) type 1 proviral hypermutation correlates with CD4 count in HIV-infected women from Kenya. Author: Land AM; Ball TB; Luo M; Pilon R; Sandstrom P; Embree JE; Wachihi C; Kimani J; Plummer FA Source: Journal of Virology. 2008 Aug Abstract: APOBEC3G is an important innate immune molecule that causes human immunodeficiency virus type 1 (HIV-1) hypermutation, which can result in detrimental viral genome mutations. The Vif protein of wild-type HIV-1 counteracts APOBEC3G activity by targeting it for degradation and inhibiting its incorporation into viral particles. Additional APOBEC cytidine deaminases have been identified, such as APOBEC3F, which has a similar mode of action but different sequence specificity. A relationship between APOBEC3F/G and HIV disease progression has been proposed. During HIV-1 sequence analysis of the vpu/env region of 240 HIV-infected subjects from Nairobi, Kenya, 13 drastically hypermutated proviral sequences were identified. Sequences derived from plasma virus, however, lacked hypermutation, as did proviral vif. When correlates of disease progression were examined, subjects with hypermutated provirus were found to have significantly higher CD4 counts than the other subjects. Furthermore, hypermutation as estimated by elevated adenine content positively correlated with CD4 count for all 240 study subjects. The sequence context of the observed hypermutation was statistically associated with APOBEC3F/G activity. In contrast to previous studies, this study demonstrates that higher CD4 counts correlate with increased hypermutation in the absence of obvious mutations in the APOBEC inhibiting Vif protein. This strongly suggests that host factors, such as APOBEC3F/G, are playing a protective role in these patients, modulating viral hypermutation and host disease progression. These findings support the potential of targeting APOBEC3F/G for therapeutic purposes. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | WOMEN | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | IMMUNE SYSTEM | IMMUNOLOGIC FACTORS | GENETICS | CYTOLOGY | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | VIRAL DISEASES | DISEASES | PHYSIOLOGY | BIOLOGY | IMMUNITY Document Number: 328351 Safer sexual behaviors after 12 months of antiretroviral treatment in Mombasa, Kenya: a prospective cohort. Author: Luchters S; Sarna A; Geibel S; Chersich MF; Munyao P Source: AIDS Patient Care and STDs. 2008 Jul Abstract: Roll-out of antiretroviral treatment (ART) raises concerns about the potential for unprotected sex if sexual activity increases with well-being, resulting in continued HIV spread. Beliefs about reduced risk for HIV transmission with ART may also influence behavior. From September 2003 to November 2004, 234 adults enrolled in a trial assessing the efficacy of modified directly observed therapy in improving adherence to ART. Unsafe sexual behavior (unprotected sex with an HIV-negative or unknown status partner) before starting ART and 12 months thereafter was compared. Participants were a mean 37.2 years (standard deviation [SD] = 7.9 years) and 64% (149/234) were female. Nearly half (107/225) were sexually active in the 12 months prior to ART, the majority (96/107) reporting one sexual partner. Unsafe sex was reported by half of those sexually active in the 12 months before ART (54/107), while after 12 months ART, this reduced to 28% (30/107). Unsafe sex was associated with nondisclosure of HIV status to partner; recent HIV diagnosis; not being married or cohabiting; stigma; depression and body mass index <18.5 kg/m(2). ART beliefs, adherence, and viral suppression were not associated with unsafe sex. After adjusting for gender and stigma, unsafe sex was 0.59 times less likely after 12 months ART than before initiation (95% confidence interval [CI] = 0.37-0.94; p = 0.026). In conclusion, although risky sexual behaviors had decreased, a considerable portion do not practice safe sex. Beliefs about ART's effect on transmission, viral load, and adherence appear not to influence sexual behavior but require long-term surveillance. Positive prevention interventions for those receiving ART must reinforce safer sex practices and partner disclosure. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | COHORT ANALYSIS | ADULTS | ANTIRETROVIRAL THERAPY | SAFER SEX | SEX BEHAVIOR | KNOWLEDGE | ATTITUDE | RISK FACTORS | TIME FACTORS | USER COMPLIANCE | INTERVENTIONS | PROGRAM EFFECTIVENESS | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | HIV | HIV INFECTIONS | VIRAL DISEASES | DISEASES | BEHAVIOR | SOCIOCULTURAL FACTORS | PSYCHOLOGICAL FACTORS | BIOLOGY | POPULATION DYNAMICS | PROGRAMS | ORGANIZATION AND ADMINISTRATION | PROGRAM EVALUATION Document Number: 328319 Maternal HLA homozygosity and mother-child HLA concordance increase the risk of vertical transmission of HIV-1. Author: Mackelprang RD; John-Stewart G; Carrington M; Richardson B; Rowland-Jones S Source: Journal of Infectious Diseases. 2008 Abstract: Mother-child human leukocyte antigen (HLA) concordance and maternal HLA homozygosity may increase the risk of vertical transmission of human immunodeficiency virus type 1 (HIV-1) risk by reducing infant immune responses. We analyzed mother-child HLA concordance and maternal HLA homozygosity in a Kenyan perinatal cohort receiving antenatal zidovudine. HLA concordance was scored as the number of shared class I alleles, and relative risk estimates were adjusted for maternal HIV-1 load. Among 277 mother-infant pairs, HIV-1 transmission occurred in 58 infants (21%), with in utero transmission in 21 (36%), peripartum transmission in 26 (45%), and transmission via breast-feeding in 11 (19%). With increased concordance, we observed a significant increase in the risk of transmission overall (adjusted hazard ratio [aHR], 1.3 [95% confidence interval {CI}, 1.0 -1.7]; P = .04), in utero (adjusted odds ratio, 1.72 [95% CI, 1.0 -1.7]; P = .04), and via breast-feeding (aHR, 1.6 [95% CI, 1.0 -2.5]; P = .04). Women with homozygosity had higher plasma HIV-1 RNA levels at 32 weeks of gestation (5.1 vs. 4.8 log10 copies/mL; P = .03) and an increased risk of transmission overall (aHR, 1.7 [95% CI, 1.1-2.7]; P = .03) and via breast-feeding (aHR, 5.8 [95% CI, 1.9 -17.7]; P = .002). The risks of overall, in utero, and breast milk HIV-1 transmission increased with HLA concordance and homozygosity. The increased risk may be due to reduced alloimmunity or less diverse protective immune responses. (author'sMother-child human leukocyte antigen (HLA) concordance and maternal HLA homozygosity may increase the risk of vertical transmission of human immunodeficiency virus type 1 (HIV-1) risk by reducing infant immune responses. We analyzed mother-child HLA concordance and maternal HLA homozygosity in a Kenyan perinatal cohort receiving antenatal zidovudine. HLA concordance was scored as the number of shared class I alleles, and relative risk estimates were adjusted for maternal HIV-1 load. Among 277 mother-infant pairs, HIV-1 transmission occurred in 58 infants (21%), with in utero transmission in 21 (36%), peripartum transmission in 26 (45%), and transmission via breast-feeding in 11 (19%). With increased concordance, we observed a significant increase in the risk of transmission overall (adjusted hazard ratio [aHR], 1.3 [95% confidence interval {CI}, 1.0 -1.7]; P = .04), in utero (adjusted odds ratio, 1.72 [95% CI, 1.0 -1.7]; P = .04), and via breast-feeding (aHR, 1.6 [95% CI, 1.0 -2.5]; P = .04). Women with homozygosity had higher plasma HIV-1 RNA levels at 32 weeks of gestation (5.1 vs. 4.8 log10 copies/mL; P = .03) and an increased risk of transmission overall (aHR, 1.7 [95% CI, 1.1-2.7]; P = .03) and via breast-feeding (aHR, 5.8 [95% CI, 1.9 -17.7]; P = .002). The risks of overall, in utero, and breast milk HIV-1 transmission increased with HLA concordance and homozygosity. The increased risk may be due to reduced alloimmunity or less diverse protective immune responses. (author's Langauage: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | MOTHER-TO-CHILD TRANSMISSION | HIV INFECTIONS | RISK FACTORS | AUTOIMMUNE RESPONSE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | EXPOSURE | HUMAN MILK | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | TRANSMISSION | INFECTIONS | DISEASES | VIRAL DISEASES | BIOLOGY | ANTIBODIES | IMMUNOLOGIC FACTORS | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | DISEASE TRANSMISSION CONTROL | PREVENTION AND CONTROL | LACTATION | MATERNAL PHYSIOLOGY Document Number: 325945 Risk compensation is not associated with male circumcision in Kisumu, Kenya: A multi-faceted assessment of men enrolled in a randomized controlled trial. Author: Mattson CL; Campbell RT; Bailey RC; Agot K; Ndinya-Achola JO Source: PLoS One. 2008 Jun Abstract: Three randomized controlled trials (RCTs) have confirmed that male circumcision (MC) significantly reduces acquisition of HIV-1 infection among men. The objective of this study was to perform a comprehensive, prospective evaluation of risk compensation, comparing circumcised versus uncircumcised controls in a sample of RCT participants. Between March 2004 and September 2005, we systematically recruited men enrolled in a RCT of MC in Kenya. Detailed sexual histories were taken using a modified Timeline Follow-back approach trichomoniasis between circumcised and uncircumcised men. These results are based on the most comprehensive analysis of risk compensation yet done. In the context of a RCT, circumcision did not result in increased HIV risk behavior. Continued monitoring and evaluation of risk compensation associated with circumcision is needed as evidence supporting its' efficacy is disseminated and MC is widely promoted for HIV prevention. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | CLINICAL TRIALS | MALE CIRCUMCISION | HIV PREVENTION | RISK BEHAVIOR | SEXUALLY TRANSMITTED DISEASES | INCIDENCE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | CLINICAL RESEARCH | RESEARCH METHODOLOGY | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | HIV INFECTIONS | VIRAL DISEASES | DISEASES | BEHAVIOR | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | MEASUREMENT Document Number: 327077 The influence and benefits of controlling for inflammation on plasma ferritin and hemoglobin responses following a multi-micronutrient supplement in apparently healthy, HIV+ Kenyan adults. Author: Mburu AS; Thurnham DI; Mwaniki DL; Muniu EM; Alumasa F Source: Journal of Nutrition Abstract: Hemoglobin and ferritin are important biomarkers of iron status but are both altered by inflammation. We used the inflammation biomarkers C-reactive protein (CRP) and alpha1-acid glycoprotein (AGP) to adjust hemoglobin and ferritin concentrations to clarify interpretation of iron status. Apparently healthy adults who tested positive twice for HIV but who had not reached stage IV or clinical AIDS were randomly allocated to receive a food supplement (n = 17 and 21) or the food plus a micronutrient capsule (MN; 10 men and 34 women, respectively) containing 30 mg iron/d. Hemoglobin, ferritin, CRP, and AGP concentrations were measured at baseline and 3 mo and subjects were divided into 4 groups (reference, no inflammation; incubating, raised CRP; early convalescence, raised AGP and CRP; and late convalescence, raised AGP). Correction factors (the ratios of the median for the reference group over each inflammatory group) improved the consistency of the ferritin but not the hemoglobin results. After correction, ferritin (but not hemoglobin) increased in both men (48 microg/L; P = 0.02) and women (12 microg/L; P = 0.04) who received MN but not in the food-only group. However, hemoglobin did improve in subjects who showed no inflammation both at baseline and mo 3 (P = 0.019), but ferritin did not increase in this group. In conclusion, ferritin concentrations were more closely linked to current inflammation than hemoglobin; hence, correction by inflammation biomarkers improved data consistency. However, low hemoglobin concentrations were the consequence of long-term chronic inflammation and improvements in response to MN supplements were only detected in subjects with no inflammation. (author's) Langauage: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | COMPARATIVE STUDIES | ADULTS | HIV POSITIVE PERSONS | HIV INFECTIONS | HEMOGLOBIN LEVEL | SERUM IRON LEVEL | FOOD SUPPLEMENTATION | VITAMINS AND MINERALS | ADMINISTRATION AND DOSAGE | HISTOCHEMICAL EFFECTS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | STUDIES | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES | HEMIC SYSTEM | PHYSIOLOGY | BIOLOGY | NUTRITION PROGRAMS | PRIMARY HEALTH CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | DRUGS | TREATMENT | MEDICAL PROCEDURES | MEDICINE | CYTOLOGIC EFFECTS Document Number: 324775 Improvement of vaginal health for Kenyan women at risk for acquisition of human immunodeficiency virus type 1: Results of a randomized trial. Author: McClelland RS; Richardson BA; Hassan WM; Chohan V; Lavreys L Source: Journal of Infectious Diseases Abstract: Vaginal infections are common and have been associated with increased risk for acquisition of human immunodeficiency virus type 1 (HIV-1). We conducted a randomized trial of directly observed oral treatment administered monthly to reduce vaginal infections among Kenyan women at risk for HIV-1 acquisition. A trial intervention of 2 g of metronidazole plus 150 mg of fluconazole was compared with metronidazole placebo plus fluconazole placebo. The primary end points were bacterial vaginosis (BV), vaginal candidiasis, trichomoniasis vaginalis (hereafter, "trichomoniasis"), and colonization with Lactobacillus organisms. Of 310 HIV-1-seronegative female sex workers enrolled (155 per arm), 303 were included in the primary end points analysis. A median of 12 follow-up visits per subject were recorded in both study arms (P = .8). Compared with control subjects, women receiving the intervention had fewer episodes of BV (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.49-0.63) and more frequent vaginal colonization with any Lactobacillus species (HR, 1.47; 95% CI, 1.19 -1.80) and H2O2-producing Lactobacillus species (HR, 1.63; 95% CI, 1.16 -2.27). The incidences of vaginal candidiasis (HR, 0.84; 95% CI, 0.67-1.04) and trichomoniasis (HR, 0.55; 95% CI, 0.27-1.12) among treated women were less than those among control subjects, but the differences were not statistically significant. Periodic presumptive treatment reduced the incidence of BV and promoted colonization with normal vaginal flora. Vaginal health interventions have the potential to provide simple, female-controlled approaches for reducing the risk of HIV-1 acquisition. 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