The Effect of Antiretroviral Therapy Initiation on the Vaginal Microbiome in HIV-Infected Women

Cindy M. Liu, Zoe R. Packman, Alison G. Abraham, David M. Serwadda, Fred Nalugoda, Maliha Aziz, Jessica L. Prodger, Rupert Kaul, Sarah Kalibbala, Ronald H. Gray, Lance B. Price, Thomas C. Quinn, Aaron Ar Tobian, Steven J. Reynolds

Research output: Contribution to journalArticle

Abstract

Background: The impact of antiretroviral therapy (ART) initiation on the vaginal microbiome is unknown. This is of particular importance among women living in sub-Saharan Africa. Understanding this relationship could help elucidate if and how the host immune system interacts with the vaginal microbiome. Methods: The vaginal microbiome of HIV-1/HSV-2-coinfected women (n = 92) in Uganda was evaluated from self-collected vaginal swabs 1 month pre-ART and at 4 and 6 months post-ART initiation. The vaginal microbiome was characterized by 16S rRNA gene-based sequencing and quantitative polymerase chain reaction. Vaginal community state types (CSTs) were identified using proportional abundance data. Changes in microbiome composition were assessed with permutational analyses of variance (PerMANOVA). Results: Five vaginal CSTs were identified, which varied significantly by bacterial load (P <. 01): CST-1 was characterized by Lactobacillus iners, CST-2 by Gardnerella, CST-3 by Gardnerella and Prevotella, CST-4 by Lactobacillus crispatus, and CST-5 was highly diverse. Vaginal microbiome composition also did not change significantly after ART initiation (P =. 985). Immune reconstitution after ART initiation did not affect vaginal microbiome CST assignment (P =. 722) or individual-level changes in bacterial load (log response ratio [interquartile range],-0.50 [-2.75 to 0.38] vs-0.29 [-2.03 to 1.42]; P =. 40). Conclusions: The vaginal microbiome of HIV-infected women was not affected by the initiation of ART or immune reconstitution in this observational study. Further research is needed to explore the long-term effects of ART treatment on the vaginal microbiome.

Original languageEnglish (US)
Article numberofz328
JournalOpen Forum Infectious Diseases
Volume6
Issue number9
DOIs
StatePublished - Oct 5 2019

Fingerprint

Microbiota
HIV
Gardnerella
Therapeutics
Bacterial Load
Prevotella
Human Herpesvirus 2
Uganda
Africa South of the Sahara
Lactobacillus
rRNA Genes
Observational Studies
HIV-1
Immune System
Analysis of Variance
Polymerase Chain Reaction

Keywords

  • anaerobes
  • antiretroviral therapy
  • HIV
  • microbiome
  • vaginal dysbiosis

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

The Effect of Antiretroviral Therapy Initiation on the Vaginal Microbiome in HIV-Infected Women. / Liu, Cindy M.; Packman, Zoe R.; Abraham, Alison G.; Serwadda, David M.; Nalugoda, Fred; Aziz, Maliha; Prodger, Jessica L.; Kaul, Rupert; Kalibbala, Sarah; Gray, Ronald H.; Price, Lance B.; Quinn, Thomas C.; Tobian, Aaron Ar; Reynolds, Steven J.

In: Open Forum Infectious Diseases, Vol. 6, No. 9, ofz328, 05.10.2019.

Research output: Contribution to journalArticle

Liu, Cindy M. ; Packman, Zoe R. ; Abraham, Alison G. ; Serwadda, David M. ; Nalugoda, Fred ; Aziz, Maliha ; Prodger, Jessica L. ; Kaul, Rupert ; Kalibbala, Sarah ; Gray, Ronald H. ; Price, Lance B. ; Quinn, Thomas C. ; Tobian, Aaron Ar ; Reynolds, Steven J. / The Effect of Antiretroviral Therapy Initiation on the Vaginal Microbiome in HIV-Infected Women. In: Open Forum Infectious Diseases. 2019 ; Vol. 6, No. 9.
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abstract = "Background: The impact of antiretroviral therapy (ART) initiation on the vaginal microbiome is unknown. This is of particular importance among women living in sub-Saharan Africa. Understanding this relationship could help elucidate if and how the host immune system interacts with the vaginal microbiome. Methods: The vaginal microbiome of HIV-1/HSV-2-coinfected women (n = 92) in Uganda was evaluated from self-collected vaginal swabs 1 month pre-ART and at 4 and 6 months post-ART initiation. The vaginal microbiome was characterized by 16S rRNA gene-based sequencing and quantitative polymerase chain reaction. Vaginal community state types (CSTs) were identified using proportional abundance data. Changes in microbiome composition were assessed with permutational analyses of variance (PerMANOVA). Results: Five vaginal CSTs were identified, which varied significantly by bacterial load (P <. 01): CST-1 was characterized by Lactobacillus iners, CST-2 by Gardnerella, CST-3 by Gardnerella and Prevotella, CST-4 by Lactobacillus crispatus, and CST-5 was highly diverse. Vaginal microbiome composition also did not change significantly after ART initiation (P =. 985). Immune reconstitution after ART initiation did not affect vaginal microbiome CST assignment (P =. 722) or individual-level changes in bacterial load (log response ratio [interquartile range],-0.50 [-2.75 to 0.38] vs-0.29 [-2.03 to 1.42]; P =. 40). Conclusions: The vaginal microbiome of HIV-infected women was not affected by the initiation of ART or immune reconstitution in this observational study. Further research is needed to explore the long-term effects of ART treatment on the vaginal microbiome.",
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AU - Liu, Cindy M.

AU - Packman, Zoe R.

AU - Abraham, Alison G.

AU - Serwadda, David M.

AU - Nalugoda, Fred

AU - Aziz, Maliha

AU - Prodger, Jessica L.

AU - Kaul, Rupert

AU - Kalibbala, Sarah

AU - Gray, Ronald H.

AU - Price, Lance B.

AU - Quinn, Thomas C.

AU - Tobian, Aaron Ar

AU - Reynolds, Steven J.

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AB - Background: The impact of antiretroviral therapy (ART) initiation on the vaginal microbiome is unknown. This is of particular importance among women living in sub-Saharan Africa. Understanding this relationship could help elucidate if and how the host immune system interacts with the vaginal microbiome. Methods: The vaginal microbiome of HIV-1/HSV-2-coinfected women (n = 92) in Uganda was evaluated from self-collected vaginal swabs 1 month pre-ART and at 4 and 6 months post-ART initiation. The vaginal microbiome was characterized by 16S rRNA gene-based sequencing and quantitative polymerase chain reaction. Vaginal community state types (CSTs) were identified using proportional abundance data. Changes in microbiome composition were assessed with permutational analyses of variance (PerMANOVA). Results: Five vaginal CSTs were identified, which varied significantly by bacterial load (P <. 01): CST-1 was characterized by Lactobacillus iners, CST-2 by Gardnerella, CST-3 by Gardnerella and Prevotella, CST-4 by Lactobacillus crispatus, and CST-5 was highly diverse. Vaginal microbiome composition also did not change significantly after ART initiation (P =. 985). Immune reconstitution after ART initiation did not affect vaginal microbiome CST assignment (P =. 722) or individual-level changes in bacterial load (log response ratio [interquartile range],-0.50 [-2.75 to 0.38] vs-0.29 [-2.03 to 1.42]; P =. 40). Conclusions: The vaginal microbiome of HIV-infected women was not affected by the initiation of ART or immune reconstitution in this observational study. Further research is needed to explore the long-term effects of ART treatment on the vaginal microbiome.

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