{"id":1246,"date":"2017-01-30T16:31:54","date_gmt":"2017-01-30T16:31:54","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1246"},"modified":"2017-01-31T16:17:21","modified_gmt":"2017-01-31T16:17:21","slug":"susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/01\/30\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\/","title":{"rendered":"Susceptibility of heterosexual sub-Saharan women to HIV could be the result of cervicovaginal microbiome characteristics"},"content":{"rendered":"<p>Could part of the explanation for the apparent susceptibility of sub-Saharan African heterosexual women to HIV infection (eight-fold that of males) lie in the bacterial flora of their female genital tract (FGT)?<\/p>\n<p>Studies published in STI journal have considered the relationship between a certain state of the FGT bacterial microbiome \u2013 especially the depletion of lactobacillus (<a href=\"http:\/\/sti.bmj.com\/content\/92\/2\/142.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Francis &amp; Grosskurth\/STIs<\/a>) \u2013 and the susceptibility to BV (<a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_1\/A304.2.abstract?sid=57050d99-eb0f-414e-b0cb-01eeb250deb4\">Antonio &amp; Hillier\/STIs<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/92\/7\/487.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Hardy &amp; Crucitti\/STIs<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/92\/2\/142.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Francis &amp; Grosskurth\/STIs<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/92\/6\/441.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Haggerty &amp; Ness\/STIs<\/a>), to pelvic inflammatory disease (<a href=\"http:\/\/sti.bmj.com\/content\/92\/6\/441.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Haggerty &amp; Ness\/STIs<\/a>), and to other STIs (<a href=\"http:\/\/sti.bmj.com\/content\/92\/2\/142.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Francis &amp; Grosskurth\/STIs<\/a>).\u00a0 Others have observed the prevalence of Lactobacillus in the healthy FGT microbiome (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A234.2.abstract?sid=57050d99-eb0f-414e-b0cb-01eeb250deb4\">Madhivanan &amp; Krupp\/STIs<\/a>), and considered the impact on the FGT lining of practices of vaginal douching (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A166.3.abstract?sid=57050d99-eb0f-414e-b0cb-01eeb250deb4\">Balkus &amp; McClelland\/STIs<\/a>), hormonal contraception (<a href=\"http:\/\/sti.bmj.com\/content\/89\/Suppl_1\/A32.2.abstract?sid=c3b22b58-2059-446a-bd96-244e18b79827\">Verwijs &amp; Wijgert\/STIs<\/a>), and sexual debut (<a href=\"http:\/\/sti.bmj.com\/content\/91\/Suppl_2\/A34.1.abstract?sid=674668c5-6489-4db7-8da7-dc541da48ec8\">Jespers &amp; Crucitti\/STIs<\/a>).<\/p>\n<p>Highly relevant to all these discussions is a recently published study by <a href=\"http:\/\/www.cell.com\/immunity\/fulltext\/S1074-7613(16)30519-2\">Gosmann &amp; Anahtar<\/a> of a prospective cohort of 236 young HIV-negative women participating in the South African Ragon Institute\u2019s <a href=\"http:\/\/www.ragoninstitute.org\/fresh-program-empowers-african-women\/\">FRESH<\/a> study (<strong>F<\/strong>emales <strong>R<\/strong>ising through <strong>E<\/strong>ducations, <strong>S<\/strong>upport and <strong>H<\/strong>ealth) in Kwa-Zulu Natal. The researchers were able to follow up their cohort for a total of 198.2 person-years, in the course of which 31 participants acquired HIV.\u00a0 The researchers distinguish four \u2018cervicotypes\u2019 in respect to FGT bacterial flora; then determine their prevalence along with their association with \u2018HIV target cells\u2019 (i.e. activated CD4 T cells expressing the HIV co-receptor CCR5) and HIV acquisition.<\/p>\n<p>The four cervicotypes correspond to the dominance of <em>Lactobacillus crispatus<\/em> and of <em>Lactobacillus iners<\/em> (CT1 and CT2, respectively), the preponderance of <em>Gardnerella vaginalis<\/em> (CT3), and a biome showing a far more diverse range of bacterial types (CT4).\u00a0 Strikingly, the first two cervicotypes (CT1 and CT2) account for only <strong>10%<\/strong> and <strong>32%<\/strong> of women in the cohort; while, among white women in Western countries, the proportion showing Lactobacillus dominance would be <strong>c.90%<\/strong>.\u00a0 The other 58% fall into the categories of high diversity communities with low Lactobacillus abundance (CT3 and CT4). \u00a0More interestingly still, <strong>none<\/strong> of the 31 HIV sero-conversions took place among the 10% of women with CT1-type bacterial flora.\u00a0 Rather, sero-conversions were fairly evenly distributed among the other three cervicotypes, with some diminution of relative incidence in the CT2 category (i.e. nine sero-conversions, as opposed to 10 and 12 in CT3 and CT4 respectively).\u00a0 Researchers observed a 17-fold increase in HIV target cells in women with a CT4-type cervico-vaginal microbiome as against those with CT1-type, and elevated levels of chemokines MIP-\u03b1 and MIP-\u03b2 which attract CCR5 expressing cells in women with diverse FGT bacterial communities.<\/p>\n<p>Sadly, regimens aiming to restore <em>Lactobacillus crispatus<\/em> dominance (e.g. antibiotics or probiotic vaginal suppositories) show significant recurrence rates.\u00a0 However, modifiable biological and behavioural factors may play a considerable role on <em>Lactobacillus<\/em> depletion in sub-Saharan African women (e.g. vaginal washing; antibiotic use; recent Trichomonas and HSV-2).\u00a0 If so, then, as <a href=\"http:\/\/sti.bmj.com\/content\/85\/5\/348.abstract?sid=57050d99-eb0f-414e-b0cb-01eeb250deb4\">Baeten &amp; McClelland\/STIs<\/a> point out, this would suggest the possibility of effective intervention strategies to reduce HIV transmission by improving vaginal health.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Could part of the explanation for the apparent susceptibility of sub-Saharan African heterosexual women to HIV infection (eight-fold that of males) lie in the bacterial flora of their female genital tract (FGT)? Studies published in STI journal have considered the relationship between a certain state of the FGT bacterial microbiome \u2013 especially the depletion of [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/30\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16496,16497,2012,1694],"tags":[],"class_list":["post-1246","post","type-post","status-publish","format-standard","hentry","category-bacterial-vaginosis","category-fgt-microbiome","category-hiv-infection","category-sti-prevention-and-surveillance"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Susceptibility of heterosexual sub-Saharan women to HIV could be the result of cervicovaginal microbiome characteristics - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/30\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Susceptibility of heterosexual sub-Saharan women to HIV could be the result of cervicovaginal microbiome characteristics - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"Could part of the explanation for the apparent susceptibility of sub-Saharan African heterosexual women to HIV infection (eight-fold that of males) lie in the bacterial flora of their female genital tract (FGT)? Studies published in STI journal have considered the relationship between a certain state of the FGT bacterial microbiome \u2013 especially the depletion of [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2017\/01\/30\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" content=\"2017-01-30T16:31:54+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2017-01-31T16:17:21+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/30\\\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/30\\\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\\\/\"},\"author\":{\"name\":\"\",\"@id\":\"\"},\"headline\":\"Susceptibility of heterosexual sub-Saharan women to HIV could be the result of cervicovaginal microbiome characteristics\",\"datePublished\":\"2017-01-30T16:31:54+00:00\",\"dateModified\":\"2017-01-31T16:17:21+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/30\\\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\\\/\"},\"wordCount\":515,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/#organization\"},\"articleSection\":[\"Bacterial vaginosis\",\"FGT microbiome\",\"HIV infection\",\"STI prevention and surveillance\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/30\\\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/sti\\\/2017\\\/01\\\/30\\\/susceptibility-of-heterosexual-sub-saharan-women-to-hiv-could-result-from-characteristics-of-their-cervicovaginal-microbiome\\\/\",\"name\":\"Susceptibility of heterosexual sub-Saharan women to HIV could be the result of cervicovaginal microbiome characteristics - 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