A Syndemic Approach to Explore Factors Associated with Bacterial Vaginosis

Salazar, Ana S.; Nogueira, Nicholas Fonseca; Rodriguez, Violeta J.; Mantero, Alejandro; Cherenack, Emily M.; Raccamarich, Patricia; Maddalon, Marissa; Brophy, Theodora; Montgomerie, Emily; Klatt, Nichole R.; Jones, Deborah L.; Alcaide, María L.

doi:10.1007/s10461-022-03634-4

Cited by 5 publications

(3 citation statements)

References 46 publications

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“…The vaginal microbiota, dominated by the Lactobacilli species that maintain high concentrations of lactic acid [ 11 ] and a low pH in the lower tract, is considered to be beneficial and reduce the risk of HIV acquisition [ 12 , 13 , 14 , 15 ]. However, multiple stimuli, including antibiotics, sexual activity, vaginal hygiene, menstrual cycle, and oral contraceptives, can alter these bacterial populations, resulting in vaginal dysbiosis and increased risk of HIV acquisition [ 12 , 16 , 17 , 18 , 19 , 20 , 21 ]. Data also indicate that the vaginal microbiome changes after menopause, with a decreased presence of Lactobacillus species compared to premenopausal women [ 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Short-Chain Fatty Acids Impair Neutrophil Antiviral Function in an Age-Dependent Manner

Carrillo‐Salinas

Parthasarathy

Lara

et al. 2022

Cells

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Half of the people living with HIV are women. Younger women remain disproportionally affected in endemic areas, but infection rates in older women are rising worldwide. The vaginal microbiome influences genital inflammation and HIV infection risk. Multiple factors, including age, induce vaginal microbial alterations, characterized by high microbial diversity that generate high concentrations of short-chain fatty acids (SCFAs), known to modulate neutrophil function. However, how SCFAs may modulate innate anti-HIV protection by neutrophils is unknown. To investigate SCFA-mediated alterations of neutrophil function, blood neutrophils from younger and older women were treated with SCFAs (acetate, butyrate and propionate) at concentrations within the range reported during bacterial vaginosis, and phenotype, migration and anti-HIV responses were evaluated. SCFA induced phenotypical changes preferentially in neutrophils from older women. Butyrate decreased CD66b and increased CD16 and CD62L expression, indicating low activation and prolonged survival, while propionate increased CD54 and CXCR4 expression, indicating a mature aged phenotype. Furthermore, acetate and butyrate significantly inhibited neutrophil migration in vitro and specifically reduced α-defensin release in older women, molecules with anti-HIV activity. Following HIV stimulation, SCFA treatment delayed NET release and dampened chemokine secretion compared to untreated neutrophils in younger and older women. Our results demonstrate that SCFAs can impair neutrophil-mediated anti-HIV responses.

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Section: Introductionmentioning

confidence: 99%

Short-Chain Fatty Acids Impair Neutrophil Antiviral Function in an Age-Dependent Manner

Carrillo‐Salinas

Parthasarathy

Lara

et al. 2022

Cells

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“…Other studies have indicated BV to be more common among people of younger age and/or those who are black; 1,2 , 24-26 however, many other factors have also been associated with increased prevalence or risk of BV and its recurrence, including low socioeconomic status, alcohol and cigarette use, having multiple sexual partners, sexual orientation, obesity, vaginal care practices, and vaginal microbiome composition. 1,2 , 7-12 , 24-29 Given the age distribution of our study population was relatively consistent with that found in other Medicaid populations (2013-2017) in the published scientific literature, 30 but the proportion of black patients was higher, our data suggest that black patients with Medicaid coverage may be more affected by BV than other race/ethnicity groups. Medicaid programs cover >16 million women of reproductive age across the United States whose income is <200% of the federal poverty level with a high representation of racially and ethnically diverse women.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States

Watkins,

Chow,

Lingohr-Smith

et al. 2023

Ann Pharmacother

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Background Bacterial vaginosis (BV) is a highly prevalent vaginal infection. Objectives Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses. Methods Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses. Results An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses. Conclusion and Relevance The high recurrence of BV represents an unmet need in women’s health care and better treatments are necessary.

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“…Individuals were reached through passive (e.g., flyers, friend & family referrals, and word-of-mouth) and active (e.g., coordinator outreach and community events) efforts as part of an on-going longitudinal study “Women, HIV, Immunology, Microbiome, and Sexual Health” (WHIMS). This study evaluates factors associated with BV recurrence using a multidisciplinary approach [ 23 ]. Referrals from the Florida Department of Health, Center for AIDS Research (CFAR), and the Center for HIV Research and Mental Health (CHARM) contributed significantly to recruitment endeavors.…”

Section: Methodsmentioning

confidence: 99%

PrEP awareness and use among reproductive age women in Miami, Florida

et al. 2023

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Background Miami, Florida is an epicenter of the HIV epidemic in the US, with 20% of new HIV infections occurring in women. Despite effectiveness of Pre-Exposure Prophylaxis (PrEP) in preventing HIV, only 10% of eligible women benefit from its use. Setting This study evaluates PrEP awareness and use, and factors associated with PrEP awareness among sexually active women in Miami, Florida. Methods Results reported in this study included cross-sectional data that were collected as part of a baseline visit from a parent study. Cis-gender, HIV-negative, 18-45-year-old, sexually active women were recruited as part of a study evaluating recurrent bacterial vaginosis and HIV risk. Participants completed questionnaires assessing socio-demographics, HIV risk factors, prior history of HIV testing and reproductive tract infections, PrEP awareness and use. Relationships between variables and PrEP awareness were analyzed and multivariable logistic regression identified variables strongly associated with PrEP awareness. Results Among the 295 women enrolled, median age was 31 (24–38) years, 49% Black, 39% White, and 34% Hispanic. Of 63% who knew about PrEP, only 5% were on PrEP. Women with income below poverty line (OR = 2.00[1.04,3.87];p = 0.04), more male sexual partners in past month (OR = 1.30[1.01,1.68];p = 0.04), lifetime HIV testing (OR = 6.42[2.83,14.52];p<0.01), and current bacterial vaginosis (OR = 2.28[1.18,4.40];p = 0.01) were more likely to be aware of PrEP. Lower odds of PrEP awareness were associated with being Black (OR = 0.38[0.15,0.96];p = 0.04), Hispanic (OR = 0.18[0.08,0.39];p<0.01), heterosexual (OR = 0.29[0.11,0.77];p<0.01), and reporting inconsistent condom use during vaginal sex (OR = 0.21[0.08,0.56];p<0.01). Conclusion PrEP awareness is low among reproductive age women in a high-risk setting. Culturally tailored interventions are needed to increase PrEP awareness and uptake, especially among Black and Hispanic women with inconsistent condom use during vaginal sex with male partners.

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A Syndemic Approach to Explore Factors Associated with Bacterial Vaginosis

Cited by 5 publications

References 46 publications

Short-Chain Fatty Acids Impair Neutrophil Antiviral Function in an Age-Dependent Manner

Short-Chain Fatty Acids Impair Neutrophil Antiviral Function in an Age-Dependent Manner

Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States

PrEP awareness and use among reproductive age women in Miami, Florida

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