Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

Low, Nicola; Chersich, Matthew; Schmidlin, Kurt; Egger, Matthias; Francis, Suzanna C.; Wijgert, Janneke van de; Hayes, Richard; Baeten, Jared M.; Brown, Joelle; Delany‐Moretlwe, Sinead; Kaul, Rupert; McGrath, Nuala; Morrison, Charles; Myer, Landon; Temmerman, Marleen; Straten, Ariane van der; Watson-Jones, Deborah; Zwahlen, Marcel; Hilber, Adriane Martin

doi:10.1371/journal.pmed.1000416

Cited by 234 publications

(277 citation statements)

References 46 publications

(93 reference statements)

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“…BV has traditionally been diagnosed using microscopy of vaginal fluid and the presence of symptoms, 3,4 and both symptomatic and asymptomatic BV have been associated with adverse reproductive health outcomes, including acquisition of HIV and other sexually transmitted infections (STIs), pelvic inflammatory disease, and preterm birth. 5,6 The vaginal mucosal barrier is dynamic and unique in the human body. It is under (cyclic) hormonal influence, has a lower pH than other mucosal barriers, and is frequently exposed to inflammatory stimuli.…”

Section: Introductionmentioning

confidence: 99%

Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier

et al. 2016

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Vaginal microbiome (VMB) dysbiosis is associated with increased acquisition of HIV. Cervicovaginal inflammation and other changes to the mucosal barrier are thought to have important roles but human data are scarce. We compared the human cervicovaginal proteome by mass spectrometry of 50 Rwandan female sex workers who had previously been clustered into four VMB groups using a 16S phylogenetic microarray; in order of increasing bacterial diversity: Lactobacillus crispatus-dominated VMB (group 1), Lactobacillus iners-dominated VMB (group 2), moderate dysbiosis (group 3), and severe dysbiosis (group 4). We compared relative protein abundances among these VMB groups using targeted (abundance of pre-defined mucosal barrier proteins) and untargeted (differentially abundant proteins among all human proteins identified) approaches. With increasing bacterial diversity, we found: mucus alterations (increasing mucin 5B and 5AC), cytoskeleton alterations (increasing actin-organizing proteins; decreasing keratins and cornified envelope proteins), increasing lactate dehydrogenase A/B as markers of cell death, increasing proteolytic activity (increasing proteasome core complex proteins/proteases; decreasing antiproteases), altered antimicrobial peptide balance (increasing psoriasin, calprotectin, and histones; decreasing lysozyme and ubiquitin), increasing proinflammatory cytokines, and decreasing immunoglobulins immunoglobulin G1/2. Although temporal relationships cannot be derived, our findings support the hypothesis that dysbiosis causes cervicovaginal inflammation and other detrimental changes to the mucosal barrier.

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Section: Introductionmentioning

confidence: 99%

Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier

et al. 2016

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“…This high rate could be explained by intravaginal pratices that are common in Africa such as cleaning inside the vagina beyond the introitus or insertion of substances into the vagina to dry or tighten the vagina [21]. In addition, Benin is a country neighboring West Africa Nigeria which comes many counterfeit products as gynecological solutions and other pharmaceutical products.…”

Section: Discussionmentioning

confidence: 99%

Bacterial Distribution and Antibiotic Susceptibility Pattern of <i>group B Streptococcus β hemolytic </i>(GBS) in Vaginal Infections at Cotonou in Benin

Tchiakpé¹,

Malick²,

Yehouenou³

et al. 2017

AJIDM

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No orthodox practices disrupt the vaginal flora and expose it to pathogenic microorganisms including group B Streptococcus β hemolytic (GBS). The study aims to describe the bacterial profil and resistance of GBS to antibiotics. Retrospective study included 640 women at Cotonou suspected of vaginal infections or vaginal discharge during 1 st January 2004 to 31 st December 2015. Three swabs were collected and analyzed to identify the bacteria by standard biochemical reactions, diagnosis of bacterial vaginosis and identification of Trichomonas vaginalis, yeasts and leukocyte count. Antibiogram was performed according to the CA-SFM. Among 640 samples, 502 (78.4%) were positive. The most encountered microorganisms were Candida albicans (37.45%) and GBS (19.92%). GBS sensitivity ranged from 80-100% for augmentin, pefloxacin and nitrofuran. But resistance was observed to netilmicin, tetracyclin, cefoxitin, cephalotin, thiamphenicol, trimethoprim / sulfamethnoxazole between 80-100%. A high percentage of resistance is the result of uncontrolled access to antibiotics and improper antibiotic policy. Routine susceptibility testing will allow to take appropriate treatment of GBS in Benin.

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“…Inflammatory conditions, which include adolescence, 46 bacterial vaginosis, and other STI [47][48][49] and the response to semen [40][41][42] may not only recruit new immune cells (as noted above) but enhance susceptibility to HIV by disrupting tight junctions and facilitating viral access to submucosal immune cells and directly augmenting HIV replication through activation of the viral promoter. 50 Inflammatory responses also induce T cell activation, which impacts PK/PD, particularly in the case of tenofovir.…”

Section: Inflammation Hormones and Drug Pk/pdmentioning

confidence: 99%

A Perspective on Progress and Gaps in HIV Prevention Science

Kiser

Mesquita

Herold

2012

AIDS Research and Human Retroviruses

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In the past few years, the transdisciplinary field of HIV prevention has reached several milestones. Topically applied tenofovir gel provided significant protection from sexual transmission of HIV in a large-scale clinical trial and oral Truvada (emtricitabine/tenofovir disoproxil fumarate) was recently approved for preexposure prophylaxis (PrEP) following two successful clinical trials in men and women. These achievements are tempered by the disappointing results of other clinical trials, which highlight the complexities of prevention research. In this perspective, we discuss scientific and developmental gaps for topical chemoprophylaxis of the sexual transmission of HIV, which depends on the complex interactions between the pharmacokinetics and pharmacodynamics of drugs, formulation and delivery systems, anatomic site of transmission, and host mucosal immune defenses. Despite the considerable time and resources devoted to unraveling the initial steps in sexual transmission of HIV, current knowledge is based on animal models and human explanted tissue, which may not fully recapitulate what happens clinically. Understanding these events, including the role that sex hormones, semen, and mucosal secretions play in transmission, and the interplay between innate immunity, the mucosal environment, and drug efficacy is paramount. This drives some of the most pressing questions in the field.

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Intravaginal Practices, Bacterial Vaginosis, and HIV Infection in Women: Individual Participant Data Meta-analysis

Abstract: Pooling of data from 14,874 women in an individual participant data meta-analysis by Nicola Low and colleagues reveals that some intravaginal practices increase the risk of HIV acquisition.

Cited by 234 publications

References 46 publications

Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier

Cervicovaginal microbiome dysbiosis is associated with proteome changes related to alterations of the cervicovaginal mucosal barrier

Bacterial Distribution and Antibiotic Susceptibility Pattern of <i>group B Streptococcus β hemolytic </i>(GBS) in Vaginal Infections at Cotonou in Benin

A Perspective on Progress and Gaps in HIV Prevention Science

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