Optimizing the vaginal microbiome as a potential strategy to reduce heterosexual HIV transmission

Armstrong, Eric; Kaul, Rupert; Cohen, Craig R.

doi:10.1111/joim.13600

Cited by 5 publications

(7 citation statements)

References 95 publications

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“…Linking microbiome findings to changes in the tumor microenvironment may be further explored, as recently reported for VSCC ( Rustetska et al, 2023 ). Novel treatments could be developed based on microbial targets, as previously attempted for bacterial vaginosis and genitourinary symptoms ( Falagas et al, 2007 ; Armstrong et al, 2022 ; Yoshikata et al, 2022 ). Studies to new treatment modalities, such as the current clinical trial applying the topical JAK-inhibitor ruxolitinib in LS, could consider assessing the microbiome composition as exploratory biomarker ( Rissmann et al, 2020 ; Papp et al, 2022 ; ClinicalTrials.gov, 2023e ).…”

Section: Discussionmentioning

confidence: 99%

The vulvar microbiome in lichen sclerosus and high-grade intraepithelial lesions

Pagan,

Huisman,

van der Wurff

et al. 2023

Front. Microbiol.

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BackgroundThe role of the vulvar microbiome in the development of (pre)malignant vulvar disease is scarcely investigated. The aim of this exploratory study was to analyze vulvar microbiome composition in lichen sclerosus (LS) and vulvar high-grade squamous intraepithelial lesions (HSIL) compared to healthy controls.MethodsWomen with vulvar lichen sclerosus (n = 10), HSIL (n = 5) and healthy controls (n = 10) were included. Swabs were collected from the vulva, vagina and anal region for microbiome characterization by metagenomic shotgun sequencing. Both lesional and non-lesional sites were examined. Biophysical assessments included trans-epidermal water loss for evaluation of the vulvar skin barrier function and vulvar and vaginal pH measurements.ResultsHealthy vulvar skin resembled vaginal, anal and skin-like microbiome composition, including the genera Prevotella, Lactobacillus, Gardnerella, Staphylococcus, Cutibacterium, and Corynebacterium. Significant differences were observed in diversity between vulvar skin of healthy controls and LS patients. Compared to the healthy vulvar skin, vulvar microbiome composition of both LS and vulvar HSIL patients was characterized by significantly higher proportions of, respectively, Papillomaviridae (p = 0.045) and Alphapapillomavirus (p = 0.002). In contrast, the Prevotella genus (p = 0.031) and Bacteroidales orders (p = 0.038) were significantly less abundant in LS, as was the Actinobacteria class (p = 0.040) in vulvar HSIL. While bacteria and viruses were most abundant, fungal and archaeal taxa were scarcely observed. Trans-epidermal water loss was higher in vulvar HSIL compared to healthy vulvar skin (p = 0.043).ConclusionThis study is the first to examine the vulvar microbiome through metagenomic shotgun sequencing in LS and HSIL patients. Diseased vulvar skin presents a distinct signature compared to healthy vulvar skin with respect to bacterial and viral fractions of the microbiome. Key findings include the presence of papillomaviruses in LS as well as in vulvar HSIL, although LS is generally considered an HPV-independent risk factor for vulvar dysplasia. This exploratory study provides clues to the etiology of vulvar premalignancies and may act as a steppingstone for expanding the knowledge on potential drivers of disease progression.

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Section: Discussionmentioning

confidence: 99%

The vulvar microbiome in lichen sclerosus and high-grade intraepithelial lesions

Pagan,

Huisman,

van der Wurff

et al. 2023

Front. Microbiol.

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“…На сьогодні взаємодії між мікроорганізмами піхви та хазяїном залишається предметом інтенсивних постійних досліджень, оскільки зміщення мікробіоти піхви від Lactobacillus до більш різноманітних видів бактерій, включаючи факультативні анаероби, призводить до розвитку бактеріального вагінозу. Наслідками останнього є, насамперед, підвищена сприйнятливість до урогенітальних інфекцій [2][3][4][5], включаючи вірус імунодефіциту людини (ВІЛ) [6], та передчасні пологи [7,8].…”

Section: Modern Approaches To Restoring Vaginal Microbiocenosis O a T...unclassified

Modern approaches to restoring vaginal microbiocenosis

Taran,

Bulavenko,

Kukuruza

et al. 2024

RHW

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The article presents literary data on the morphology and types of vaginal lactobacilli, pathological changes in the vaginal environment, as well as modern possibilities of restoring the vaginal microflora of a woman’s organism. Certain regularities regarding the connection of bacterial vaginosis with intestinal dysbiosis have been observed, which indicates a single dysbiotic process in the organism with a dominant manifestation either in the sexual or digestive system.A review of scientific publications of recent years shows the significant influence of intestinal dysbiosis, infectious and inflammatory diseases of the stomach and intestines, as well as the oral use of antibacterial drugs on the quantitative and qualitative composition of the vaginal microflora in women. It was found that an increased number of opportunistic microorganisms (85%) and a decreased number of lactobacilli and bifidobacteria (less than 70%) in the intestine are associated with a rise in the content of opportunistic microorganisms in the vaginal biota in women with infectious and inflammatory diseases of the reproductive system. This is explained by the ability of saprophytes and opportunistic microorganisms to penetrate into the reproductive organs of women by increasing the permeability of the mucous membrane of the intestinal wall, as well as into the vascular bed, which can be observed, for example, on the background of antibiotic use. The antibiotic use in a number of cases leads to a closed circle, when the need for antibacterial therapy to eliminate one infection leads to a deepening of dysbiosis and an increased number of other pathogens.Numerous studies have demonstrated the effectiveness of selective decontamination (selective elimination of pathogens) in combination with a probiotic, prebiotic or synbiotic to restore vaginal microbiocenosis.Our experience of using an oral synbiotic (1 capsule contains 5 billion colony-forming units of Lactobacillus plantarum lyophilizate pcs. 8Р-AZ, Lactobacillus fermentum pcs. 90Т-С4 and prebiotic inulin, once a day 30 minutes before meal for 7–10 days) in a complex therapy of bacterial vaginosis in non-pregnant women of reproductive age indicates faster elimination of systemic dysbiosis and restoration of normal intravaginal flora. Thus, regression of complaintsand normalization of objective data was determined on average for 2.9 days versus 4.7 days in women who were not administered the drug.The obtained data show that a systemic synbiotic containing a lyophilized microbial mass of probiotic lactobacteria, products of their metabolism and inulin (prebiotic) creates an additional effect in restoring normal biocenosis and the immune mechanism of ensuring colonization resistance of the body’s mucous membranes.

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“…On the opposite, the higher HIV risk is associated with CST IV (the diversity group, encompassing bacterial vaginosis and aerobic vaginitis/desquamative inflammatory vaginitis). The role of CST III (L. iners) is more controversial but seems to be a less favorable profile [18][19][20]. The protective effect against HIV is partially mediated by extracellular vesicles released by the symbiotic bacteria [21].…”

Section: The Female Genitourinary Tract In Wlhivmentioning

confidence: 99%

Low genitourinary tract risks in women living with the human immunodeficiency virus

et al. 2023

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This review analyzes the clinical associations between specific low genitourinary tract clinical circumstances in peri-and postmenopausal women living with human immunodeficiency virus (WLHIV). Modern antiretroviral therapy (ART) improves survival and reduces opportunistic infections and HIV transmission. Despite appropriate ART, WLHIV may display menstrual dysfunction, risk of early menopause, vaginal microbiome alterations, vaginal dryness, dyspareunia, vasomotor symptoms, and low sexual function as compared to women without the infection. They have increased risks of intraepithelial and invasive cervical, vaginal, and vulvar cancers. The reduced immunity capacity may also increase the risk of urinary tract infections, side effects or toxicity of ARTs, and opportunistic infections, Menstrual dysfunction and early menopause may contribute to the early onset of vascular atherosclerosis and plaque formation, and increased osteoporosis risks requiring specific early interventions. On the other hand, the association between being postmenopausal and having a low sexual function is significant and related to low adherence to ART. WLHIV deserve a specific approach to manage different low genitourinary risks and complications related to hormone dysfunction and early menopause.

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Optimizing the vaginal microbiome as a potential strategy to reduce heterosexual HIV transmission

Cited by 5 publications

References 95 publications

The vulvar microbiome in lichen sclerosus and high-grade intraepithelial lesions

The vulvar microbiome in lichen sclerosus and high-grade intraepithelial lesions

Modern approaches to restoring vaginal microbiocenosis

Low genitourinary tract risks in women living with the human immunodeficiency virus

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