1. Defining characteristics of genital health in South African adolescent girls and young women at high risk for HIV infection.
- Author
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Dabee S, Barnabas SL, Lennard KS, Jaumdally SZ, Gamieldien H, Balle C, Happel AU, Murugan BD, Williamson AL, Mkhize N, Dietrich J, Lewis DA, Chiodi F, Hope TJ, Shattock R, Gray G, Bekker LG, Jaspan HB, and Passmore JS
- Subjects
- Adolescent, CD4-Positive T-Lymphocytes immunology, Cervix Uteri cytology, Cervix Uteri immunology, Cervix Uteri microbiology, Cohort Studies, Cytokines immunology, Cytokines metabolism, Estrogens blood, Estrogens immunology, Female, HIV Infections prevention & control, Humans, Hydrogen-Ion Concentration, Lactobacillus crispatus immunology, Lactobacillus crispatus isolation & purification, Progesterone blood, Progesterone immunology, Risk Factors, South Africa epidemiology, Vagina cytology, Vagina immunology, Vaginosis, Bacterial blood, Vaginosis, Bacterial immunology, Young Adult, HIV Infections immunology, Microbiota immunology, Vagina microbiology, Vaginosis, Bacterial epidemiology, Women's Health statistics & numerical data
- Abstract
The genital tract of African women has been shown to differ from what is currently accepted as 'normal', defined by a pH≤4.5 and lactobacilli-dominated microbiota. Adolescent girls and young women (AGYW) from sub-Saharan Africa are at high risk for HIV, and we hypothesized that specific biological factors are likely to be influential. This study aimed to compare characteristics of vaginal health in HIV-negative AGYW (16-22-years-old), from two South African communities, to international norms. We measured plasma hormones, vaginal pH, presence of BV (Nugent scoring), sexually transmitted infections (multiplex PCR for Chlamydia trachomatis, Neisseria gonorrhoea, Trichomonas vaginalis, Mycoplasma genitalium) and candidiasis (Gram stain) in AGYW (n = 298) from Cape Town and Soweto. Cervicovaginal microbiota was determined by 16S pyrosequencing; 44 genital cytokines were measured by Luminex; and cervical T-cell activation/proliferation (CCR5, HLA-DR, CD38, Ki67) was measured by multiparametric flow cytometry. 90/298 (30.2%) AGYW were negative for BV, candidiasis and bacterial STIs. L. crispatus and L. iners were the dominant bacteria in cervicovaginal swabs, and the median vaginal pH was 4.7. AGYW with L. crispatus-dominant microbiota (42.4%) generally had the lowest cytokine concentrations compared to women with more diverse microbiota (34/44 significantly upregulated cytokines). Frequencies of CCR5+CD4+ T-cells co-expressing CD38 and HLA-DR correlated positively with interleukin (IL)-6, TNF-α, GRO-α, macrophage inflammatory protein (MIP)-1α, and IL-9. While endogenous oestrogen had an immune-dampening effect on IL-6, TNF-related apoptosis-inducing ligand (TRAIL) and IL-16, injectable hormone contraceptives (DMPA and Net-EN) were associated with significantly lower endogenous hormone concentrations (p<0.0001 for oestrogen and progesterone) and upregulation of 34/44 cytokines. Since genital inflammation and the presence of activated CD4+ T cells in the genital tract have been implicated in increased HIV risk in South African women, the observed high levels of genital cellular activation and cytokines from AGYW may point towards biological factors increasing HIV risk in this region., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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