Different and diverse anaerobic microbiota were seen in women living with HIV with unsuppressed HIV viral load and in women with recurrent bacterial vaginosis: a cohort study

Abstract

Objective To compare the vaginal microbiota of women living with HIV (WLWH) with the vaginal microbiota of women with recurrent bacterial vaginosis (BV) and healthy women without HIV to determine if there are differences in the vaginal microbiome, what factors influence these differences, and to characterise HIV clinical parameters including viral load and CD4 count in relation to the vaginal microbiome.Design Observational cohort study.Setting Canada.Population Women aged 18-49 years who were premenopausal and not pregnant were recruited into three cohorts: healthy women, WLWH and women with recurrent BV.Methods Demographic and clinical data were collected via interviews and medical chart reviews. Vaginal swabs were collected for Gram-stain assessment and microbiome profiling using the cpn60 barcode sequence.Main outcome measures To compare overall community composition differences, we used compositional data analysis methods, hierarchical clustering and Kruskal-Wallis tests where appropriate.Results Clinical markers such as odour and abnormal discharge, but not irritation, were associated with higher microbial diversity. WLWH with unsuppressed HIV viral loads were more likely than other groups to have non-Gardnerella-dominated microbiomes. HIV was associated with higher vaginal microbial diversity and this was related to HIV viral load, with unsuppressed women demonstrating significantly higher relative abundance of Megasphaera genomosp. 1, Atopobium vaginae and Clostridiales sp. (all P < 0.05) compared with all other groups. ConclusionsIn WLWH, unsuppressed HIV viral loads were associated with a distinct dysbiotic profile consisting of very low levels of Lactobacillus and high levels of anaerobes.Keywords Bacterial vaginosis, cpn60, HIV, vaginal microbiome, women's health.Tweetable abstract Vaginal microbiomes in WLWH with viral load >50 copies/ml have distinct dysbiotic profiles with high levels of anaerobes.

The Female Vaginal Microbiome in Health and Bacterial Vaginosis

“…HIV infection is diagnosed in over 1 million females yearly, and BV is a major risk factor of HIV infection (Klatt et al, 2017). For instance, BV is linked to a greater risk of HIV infection (Taha et al, 1998;Myer et al, 2005), and the level of HIV is greater in the vaginal discharge of women who are infected with HIV and BV than in those of women who are infected with HIV but have no BV (Cu-Uvin et al, 2001;Sha et al, 2005;Elwood et al, 2020). In Uganda, compared with the frequency of HIV-1 in women with normal vaginal flora (14.2%), a markedly elevated frequency (26.7%) was observed in women with severe BV (Nugent scores 9-10) (Ledru et al, 1997).…”

Interactions between microbiota and cervical epithelial, immune, and mucus barrier

“…HIV with unsuppressed viral loads are more likely to have higher abundance of Megasphaera genomosp.1, A. vaginae, and Clostridiales sp. compared to healthy and recurrent BV patients (Elwood et al, 2020). Relative studies are summarized in Supplementary Table 2.…”

Population genetic analyses of longitudinal vaginal microbiome reveal racioethnic evolutionary dynamics and prevailing positive selection ofLactobacillusadhesins

“…We can observe that Lactobacillaceae and non-Lactobacillaceae species were distributed diagonally in the second and fourth quadrants, respectively (Figures S10M). Besides Gardnerella vaginalis and Fannyhessa vaginae, other species in the fourth quadrant were also found to be associated with gynecological disease [83][84][85][86][87] . Particularly, Lactobacillus iners and Aerococcus christensenii were near the middle of the diagonal, with the former being an inimical Lactobacillus species and the latter an uncommon pathogen 60,88 .…”