Effect of Trichomoniasis Therapy on Genital HIV Viral Burden Among African Women

BACKGROUND: Our objective was to test the hypothesis that treatment for trichomoniasis among HIV-infected women not taking antiretrovirals in South Africa would be associated with decreased HIV genital shedding. METHODS: HIV-infected women presenting for routine HIV care were screened for trichomoniasis using self-collected vaginal swabs with a rapid point-of-care immunochromatographic antigen test. Women testing positive were offered enrollment into a prospective cohort study if they had documented HIV infection were aged 18 to 50 years and were not receiving antiretroviral therapy. Recent use of postexposure prophylaxis or antibiotic therapy active genital ulcers or systemic illness were exclusion criteria. Cervical swabs were collected for gonococcal and chlamydial testing and those testing positive were excluded. Women were treated with directly observed oral therapy with 2 g of oral metronidazole. A follow-up visit was scheduled 1 month after therapy and partner letters were provided. Paired cervical wicks and plasma were collected for viral load measurement. RESULTS: In all 557 women were screened. Sixty tested positive for trichomoniasis 10 subsequently met exclusion criteria and 4 were lost to follow-up. Of 46 women evaluated at follow-up 37 (80.4%) were cured. Plasma viral load was not significantly different after therapy (P = 0.93). Genital tract viral load decreased by 0.5 log10 (P < 0.01). The mean genital tract viral load (log10) decreased from 4.66 (