Trichomonas vaginalis and HIV infection acquisition: a systematic review and meta-analysis

Abstract

Objectives: Trichomoniasis is the most prevalent curable STI globally, with the highest incidence and prevalence in sub-Saharan Africa (sSA). STIs have largely been associated with an increase in HIV acquisition. Our objective was to assess the existing literature available in English regarding the association of Trichomoniasis and HIV-1 acquisition.

Methods: The review protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under number CRD42018082702. We searched MEDLINE, Embase and Scopus databases to collect articles measuring the association of Trichomonas vaginalis infection and HIV acquisition and performed a meta-analysis and qualitative synthesis of the literature.

Results: We identified 1806 unduplicated citations, of which 18 papers and 1 conference abstract were eligible for inclusion in the review after applying our inclusion and exclusion criteria. All the studies included in the systematic review had been carried out in sSA. The articles reported various measures of effects, namely: HRs, rate ratios, risk ratios and ORs. In a meta-analysis restricted to 11 studies reporting HR, individuals infected with T. vaginalis were 1.5 times more likely to acquire HIV compared with individuals not infected with T. vaginalis (95% CI 1.3 to 1.7; p<0.001).

Conclusions: T. vaginalis is an important factor in HIV acquisition especially in sSA where the prevalence of both T. vaginalis and HIV-1 are high. This systematic review and meta-analysis confirms the evidence that infection with T. vaginalis augments HIV acquisition with 50%. Diagnosis and treatment of T. vaginalis infection in both high-risk and low-risk individuals may be a potential tool to reduce new HIV infections.

Trial registration number: CRD42018082702.

Keywords: Africa; HIV; meta-analysis; systematic review; trichomonas.

Figure 1

Identification of studies included in the systematic review. HIV, human immunodefeciency virus; TV, Trichomonas vaginalis

Figure 2

Funnel plot to assess publication bias among studies evaluating the association between Trichomonas vaginalis infection and HIV infection acquisition. The triangles represent the estimates of the 11 included studies of the association between T. vaginalis infection and HIV infection acquisition. The log of the HR is plotted on the horizontal axis, against the inverse of the SE of the HR on the vertical axis. The vertical line in the funnel plot indicates the fixed-effects summary estimate and the sloping lines indicate the expected 95% CIs for a given SE.

Figure 3

Forest plot of estimates of association between trichomoniasis and HIV acquisition. Studies are plotted to start with the one with the least weight. Each study is represented by a black circle and a horizontal line, which correspond to the HR and 95% CI, respectively. The area of the grey box around each study reflects the weight of the study (determined by random effects analysis) in the meta-analysis. The vertical line in the middle corresponds to an HR of 1.0. The diamond represents the overall HR with the 95% CI given by its width. The arrow indicates the study with the highest confidence interval. There was low heterogeneity of studies included in the meta-analysis as shown by the I²=0.0%, p=0.510.