Paper # 754
Vitamin D Deficiency and Bacterial Vaginosis among HIV-infected and -uninfected Women in the US
Audrey French1,2, O Adeyemi1,2, D Agniel2, M Yin3, K Anastos4, and M Cohen1,2
1Rush Univ Med Ctr, Chicago, IL, US; 2CORE Ctr, Stroger Hosp of Cook County, Chicago, IL, US; 3Columbia Univ Med Ctr, New York, NY, US; and 4Montefiore Med Ctr, Bronx, NY, US
Background: Bacterial vaginosis (BV), the most frequent
cause of vaginitis, is associated with morbidities such as premature labor and
increased susceptibility to HIV. Recently an association between vitamin D deficiency
(VDD) and BV was identified in pregnant women. We sought to replicate this
finding in the Women’s Interagency HIV Study (WIHS).
Method: A cross-sectional study of women
participating in the WIHS, a longitudinal study of women with and at risk for
HIV. Women in this substudy were from Chicago or New York. BV was defined by
the Amsel criteria. VDD was defined as 25 (OH) D ≤20 ng/mL and
insufficiency as >20 and ≤30 ng/mL.
Results: Among 609 women studied (6 of whom were
pregnant), BV was found in 19% (table). VDD was found in 60% and insufficiency
in 23.5%. VDD was associated with black race, 268 of 397 vs 59 of 92 for whites,
OR 3.16 (95%CI, 2.06 to 4.89), but not with HIV status, CD4, or age. Vitamin D level
strongly correlated with BV (r= –0.14, P <0.001) and there was
a dose response relationship; BV was most likely in women with VDD (OR 3.55),
then women with insufficient levels (OR 2.12) compared with sufficient vitamin
D. In multivariate analysis black race, AOR 6.03, VDD, AOR 2.46, and number of
sex partners, AOR 1.54, were independently associated with BV.
Conclusions: In this study of 609 HIV-infected and -uninfected
women, BV and VDD were common and significantly correlated. VDD may partially
explain the relationship between black race and BV and may be a modifiable risk
factor for the disorder. Further study is needed to determine whether repletion
of vitamin D will decrease the occurrence of BV.
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Univariate
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Multivariate
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Non–BV
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BV
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OR
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95%CI
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P
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Adjusted
OR
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95%CI
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P
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HIV infected
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400
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84
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0.61
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0.38–0.98
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0.042
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0.80
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0.47–1.38
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0.428
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HIV
uninfected
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93
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32
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1.00
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Race
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|
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White
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144
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7
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1.00
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1.00
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Black
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293
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104
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7.14
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3.46–17.4
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<0.001
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6.03
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2.64–13.78
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<0.001
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Other
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53
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4
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1.57
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0.38–5.57
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0.504
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1.40
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0.38–5.20
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0.603
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Vitamin D
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> 30
ng/mL
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94
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8
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1.00
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|
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1.00
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|
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>20–30
ng/mL
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120
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23
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2.12
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0.93–5.34
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0.074
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1.57
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0.63–3.91
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0.320
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≤20
ng/mL
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279
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85
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3.55
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1.75–8.27
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<0.001
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2.46
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1.09–5.56
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0.027
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Sex
partners in last 6 months
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|
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0
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173
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18
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1.00
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1.54*
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1.14–2.08
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0.005
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|
1
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265
|
75
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2.70
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1.59–4.81
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<0.001
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|
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2
|
31
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13
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4.01
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1.75–9.04
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0.001
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>2
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15
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8
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5.09
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1.81–13.65
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0.003
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Mean
age
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41.9
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39.7
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2.66
(t
value)
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0.008
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0.85*
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0.62–1.17
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0.313
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HIV–infected
women n=484
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HAART
use
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|
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No
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225
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56
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1.00
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|
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1.00
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|
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Yes
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175
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28
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0.64
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0.39–1.05
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0.079
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1.07
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0.54–2.09
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0.851
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CD4
count
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>500
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133
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24
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1.00
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|
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1.00
|
|
|
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200–500
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180
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34
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1.04
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0.59–1.87
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0.880
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0.96
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0.50–1.84
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0.911
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<
200
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78
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26
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1.84
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0.99–3.46
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0.055
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1.16
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0.51–2.62
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0.714
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Mean
gog HIV RNA
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7.30
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8.37
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3.19
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0.002
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1.47*
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0.76–2.83
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0.186
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*OR for
linear increase
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