Article

Altered Vaginal Microbiota Are Associated With Perinatal Mother-to-Child Transmission of HIV in African Women From Burkina Faso

Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Denver, CO, USA.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 02/2012; 60(3):299-306. DOI: 10.1097/QAI.0b013e31824e4bdb
Source: PubMed

ABSTRACT

Mother-to-child transmission (MTCT) of HIV remains a significant problem in resource-limited settings, despite the advent of antiretroviral therapies. Because perturbations in vaginal microbial communities are associated with sexual transmission of HIV, we determined whether perinatal MTCT is associated with the vaginal microbiotas of HIV-infected mothers.
We conducted a retrospective analysis of cervicovaginal microbiotas by pyrosequencing of bacterial 16S rRNA genes (median 350 sequences per sample) from 10 transmitters and 54 nontransmitters during a perinatal MTCT prevention clinical trial of azidothymidine and the microbicide benzalkonium chloride. Logistic regression was performed adjusting for multiple covariates, including CD4(+) T-cell numbers and treatment group, to correlate abundances of microbial taxa with perinatal MTCT.
The vaginal microbiotas of these subjects were dominated by several lactobacilli species, although a subset of subjects was colonized by diverse anaerobic species. MTCT of HIV was associated with significantly greater relative abundances of several groups of microorganisms. Most notably, among the abundant bacterial species, Gardnerella vaginalis was significantly enriched in cases of antepartum transmission, compared with nontransmission (odds ratio 1.7; P = 0.004). Neither azidothymidine nor benzalkonium chloride treatment was associated with shifts in microbial distributions compared with the placebo control group.
These data suggest that alterations in vaginal microbial communities are associated with an increased risk for perinatal MTCT, consistent with results with horizontal transmission of HIV. Therefore, determining the mucosal features associated with alterations in vaginal microbial communities may guide efforts to modulate the risk for HIV MTCT.

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    • "If the bacterium ascends into the uterine environment , these inflammatory conditions in the upper genital tract could be detrimental to the amniotic membrane, leading to increased permeabilization and irritation of the cervix, both of which can lead to preterm birth (Buhimschi et al., 2005). BV also significantly increases the likelihood of HIV transmission both during pregnancy and postpartum, with the presence of G. vaginalis particularly associated with antepartum transmission (Frank et al., 2012). Inflammatory cytokines can also cause an increase in leukocyte infiltrate, providing a direct method for HIV binding to CD4 receptors and co-receptors. "
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