h Trichomonas vaginalis was associated with a significantly increased risk of becoming infected with HIV (hazard ratio, 1.60, p = 0.01). This association remained statistically significant after adjustment for sexual risk behaviours, sexually transmitted infections, and the other potential confounding factors noted above (adjusted hazard ratio, 1.52; p = 0.03).

The investigators then turned their attention to the factors associated with Trichomonas vaginalis infection. They found that it was significantly related to shorter duration of prostitution (p < 0.001), under eight years of education (p < 0.001) and concurrent cervicitis (p < 0.001) and bacterial vaginosis (p < 0.001).

Unsurprisingly, 100% condom use was associated with a lower risk of Trichomonas vaginalis, as was the use of progesterone-only contraceptives.

“In the present prospective study, infection with Trichomonas vaginalis was associated with a significantly increased risk of HIV-1 acquisition”, write the investigators.

They suggest several possible reasons why infection with Trichomonas vaginalis increases the risk of HIV acquisition:

· Trichomonas vaginalis leads to inflammation, resulting in cells vulnerable to HIV infection being present in the vaginal and cervical mucosa.
· Trichomonas vaginalis could cause mucosal haemorrhage, damaging natural defences against infection.
· Trichomonas vaginalis undermines a process that can prevent HIV’s attachment to cells.
· Trichomonas vaginalis increases the risk of HIV by increasing susceptibility to vaginal infections or the persistence of abnormal vaginal flora.

The investigators believe that their findings have important implications for HIV prevention. It is thought that 6% of HIV-positive women in the US acquired the infection because of Trichomonas vaginalis, and there is a high incidence of Trichomonas vaginalis in Africa.

The investigators therefore conclude,
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