PREVALENCE OF HIV AMONG WOMEN WITH VAGINAL DISCHARGE: DISCUSSION
Persons with HIV infection who subsequently develop an acute STD have an increased probability of transmitting HIV, as persons with acute STDs have increased probability of acquiring HIV. STDs, therefore, play an important role in the transmission of HIV Its prevention, thus, becomes important in the prevention of HIV.
In this study, 2.9% of patients with vaginal discharge were HIV positive. This is far lower than the prevalence rate of 6.7% in Lagos and the national prevalence rate of 5.4%. The reasons for this may be because we sought the consent of the patients before performing the HIV serotest. It may be possible that those patients who strongly believed that they could have HIV were not brave enough to accept getting the test. Perhaps if we had done anonymous testing, we would have had a higher prevalence rate. The rates found in the last sentinel survey in Nigeria were obtained by anonymous testing. Secondly, the study was hospital-based, which was not quite a true representation of the population; a community-based study may have perhaps shown a higher prevalence. These reasons notwithstanding, a prevalence rate of 2.9% could still be considered as being high. Apcalis Oral Jelly
All the four patients who were HIV seropositive were married and had children. This is not surprising, as it is well-documented that heterosexual transmission is the predominant mode of spread of HIV in sub-Saharan Africa. All the patients who were HIV seropositive were petty traders, usually of very low income. Even though only one of them admitted to having more than one sexual partner, it would not be incorrect to speculate that extramarital affairs to raise money to supplement income is particularly rife among petty traders.
Candida albicans was found in all the HIV seropositive patients. This organism is one of the common organisms that causes vaginal discharge among Nigerian women. It was also the most common organism found in the patients in our study. Recently, it was reported that women infected with HIV were more likely to have prevalent vulvovaginal candidiasis (OR 1.8 CI 1.0-3.25 p=0.05), and the annual incidence rate was 4%. It is therefore not surprising that in our study, Candida albicans was the common organism found in the HIV-positive women. Other studies have also confirmed that immunocompromised HIV-1 infected women are known to have increased rates of vaginal candidiasis. Candida albicans often infects the vaginal mucosa when there is no significant reduction in CD4 lymphocyte count. Thus, vulvovaginal candidiasis, unlike oropharyngeal and oesophageal candidiasis that are associated with significant reduction in CD4 lymphocytes counts (CD4 below O.lx 104/L in oesophageal candidiasis), often occurs early in the course of HIV infection. In one study, chronic candidiasis was the presenting complaint in 24% of HIV infected females. Another study found 64 (35%) of 184 HIV-seropositive women to have vaginal swabs positive for yeast.
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Going by these reports, it is possible that the women in our study may have acquired HIV infection before developing the vulvovaginal candidiasis and that they might have been in the early stage of the infection. Vaginal candidiasis is reported to be associated with a significant increase in HIV-1 shedding by cells of the vagina. It may therefore increase the infectivity of an HIV-seropositive woman. This would mean treating an HIV-positive woman with vulvovaginal candidiasis would decrease transmission of the virus to her sexual partners and even to future children. Also treating women who have vulvovaginal candidiasis may reduce their chances of acquiring HIV infection. This is worthy of note especially here in Nigeria, where candidiasis is a common cause of vaginal discharge and HIV infection has reached epidemic levels with the prevalence rising exponentially.
Other conditions that cause vaginal discharge— like bacterial vaginosis, trichomoniasis, gonococcal, and chlamydia cervicitis—have been found in different studies to be more common in HIV-seropositive women. We were not able to demonstrate this in our study, possibly because the number we studied was small. Also the prevalence of some of the organisms in our study population were too small for us to make any meaningful deductions. We hope to carry out a community-based study on this subject in the nearest future. cheap antibiotics
The predominance of Candida albicans infection in HIV patients in our study infers that patients with vulvovaginal candidiasis, especially those with chronic cases, may need to be counseled for HIV screening. This may help in the early diagnosis of the disease so that appropriate interventions could be taken to prevent early progress into AIDS. More importantly, it may prevent spread to partners and to future children and, thus, help reduce the prevalence of the disease in the society at large. As the voluntary testing for HIV in Nigeria is only 16.5%, we hope that the result of this study may help in persuading patients with pathologic vaginal discharge to have voluntary testing for HIV
