Treatment Failure Of Trichomonas Vaginalis Among Hiv+ Women: Risk Factors And Methods
Background: Trichomoniasis is the most common non-viral sexually transmitted infection with worldwide; it is particularly prevalent amongst HIV positive women. The infection is commonly considered easily treatable, yet repeat infection rates in HIV positive women can be as high as 36%. The overall objectives of this thesis is to examine the influence of select factors on treatment failure and retest positive of Trichomonas vaginalis (TV) among HIV+ women and to examine methodologies for eliciting reports of sexual behaviors. Methods: A secondary data analysis was performed on a multi-centered cohort of HIV+/TV+ women who were randomized to single-dose (2g) or 7 day (500mg BID) multi-dose metronidazole treatment. Test of cure visit occurred 6-12 days after treatment completion and women returned for a 3-month re-test visit. To assess sexual behavior methods a literature search was conducted for articles that compared prospective and recall methods. Results: Women on ART had higher retest positive than women not on ART with an increased relative risk of 2.63 (95% CI 1.04-6.63, p=0.036). Of the 143 women included for the assessment of smoking, the higher level of smoking had an increased risk of TV compared to non-smokers 3.44 RR (95% CI 1.31-9.04, p-value=0.012) and Cochran-Armitage trend test at p=0.007 between increasing levels of smoking and TV+. Out of an initial 3140 articles, 14 met all the criteria for review. Among heterosexuals, recall of 1 month of sexual behavior was found to be similar to data collected more frequently (i.e. daily, over the same time span). Conclusions: Among HIV positive women, ART usage and cigarette smoking may interfere with treatment of TV. Monthly recall methods appear to be similar to daily measures of sexual behavior among heterosexuals.