Female Genital Schistosomiasis and HIV-1 Incidence in Zambian Women: A Retrospective Cohort Study

30 Jun 2021
Amy S Sturt, Emily L Webb, Comfort R Phiri, Maina Mudenda, Joyce Mapani, Barry Kosloff, Maina Cheeba, Kwame Shanaube, Justin Bwalya, Eyrun F Kjetland, Suzanna C Francis, Paul L A M Corstjens, Govert J van Dam, Lisette van Lieshout, Isaiah Hansingo, Helen Ayles, Richard J Hayes, Amaya L Bustinduy


Female genital schistosomiasis (FGS) has been associated with prevalent HIV-1. We estimated the incidence of HIV-1 infection in Zambian women with and without FGS.


Women (aged 18–31, nonpregnant, sexually active) were invited to participate in this study in January–August 2018 at the final follow-up of the HPTN 071 (PopART) Population Cohort. HIV-1-negative participants at enrollment (n = 492) were included in this analysis, with testing to confirm incident HIV-1 performed in HPTN 071 (PopART). The association of incident HIV-1 infection with FGS (Schistosoma DNA detected by polymerase chain reaction [PCR] in any genital specimen) was assessed with exact Poisson regression.


Incident HIV-1 infections were observed in 4.1% (20/492) of participants. Women with FGS were twice as likely to seroconvert as women without FGS but with no statistical evidence for a difference (adjusted rate ratio, 2.16; 95% CI, 0.21–12.30; P = .33). Exploratory analysis suggested an association with HIV-1 acquisition among women with ≥2 positive genital PCR specimens (rate ratio, 6.02; 95% CI, 0.58–34.96; P = .13).


Despite higher HIV seroconversion rates in women with FGS, there was no statistical evidence of association, possibly due to low power. Further longitudinal studies should investigate this association in a setting with higher schistosomiasis endemicity.