Prevalence and Risk Factors for Development of Asymptomatic Bacteriuria Among HIV Positive Pregnant Women in Jos, Nigeria

Abstract

The Human Immunodeficiency Virus pandemic is negatively affecting the reproductive health of women in Nigeria. It is associated with increased morbidity and mortality, especially where secondary infections exist. Studies document that HIV positive women are prone to reproductive and urinary tract infections, and due to physiologic changes in pregnancy, there is higher incidence of urinary infections among pregnant women, with or without symptoms. This prospective cohort study investigates for asymptomatic bacteriuria in pregnancy among HIV seropositive women, to identify if HIV positivity confers additional risks for occurrence. We recruited 119 pregnant HIV positive women and 152 HIV negative controls from Jos University teaching hospital and Faith Alive hospital in Jos, Nigeria and screened for asymptomatic bacteriuria. Bacteriuria was confirmed when two separate urine samples, in the same woman, showed presence of 105 CFU/ml (100,000 organisms) of same species. Laboratory personnel performing tests were unaware of participants HIV status. Antibiotic sensitivity were determined and participants were followed-up/evaluated for features of pyelonephritis throughout antenatal care. Prevalence was determined and analysis to determine if HIV positivity conferred risks. There were 22 women with confirmed bacteriuria, with prevalence of 8.1% among all participants, with 9.4% (14) among HIV Negative cohort and 6.8% (8) of HIV positive women. HIV status, demography and previous pyelonephritis/UTI were not statistically associated with development of asymptomatic bacteriuria. Two women with medical conditions (Diabetes and Sickle cell disease) had confirmed bacteriuria, but numbers were insufficient to deduce an association. Staphylococcus aureus predominated (78.6%) among HIV negative, while for HIV positive women, Escherichia coli and Staphylococcus aureus each affected 44.4%. Antibiotic sensitivity favoured Cefuroxime in both HIV positive and negative women, but organisms were resistant to penicillins and Nitrofurantoin. Treatment was not possible because of antibiotics cost and/or unwillingness of participants to receive treatment for an asymptomatic condition. Analysis of the HIV positive cohort showed no further conferment of risk by CD4 counts, viral load, duration of HIV positivity, the anti-retroviral drug type/class or duration/adherence to ARVs. No woman with CD4 count >500 cells/mm3 developed asymptomatic bacteriuria but there was no statistical association. Similarly, women who had undetectable viral load had lower bacteriuria rates, while women with high viral load had higher rates of asymptomatic bacteriuria, but this was only significant when analysis was performed using the logarithm of viral load.