Abstract
Background:Although nonoptimal vaginal bacteria and inflammation have been associated with increased HIV risk, the upstream drivers of these phenotypes are poorly defined in young African women.Setting:Mombasa, Kenya.Methods:We characterized vaginal microbiome and cytokine profiles of sexually active young women aged 14-24 years (n = 168) in 3 study groups: those engaging in formal sex work, in transactional sex, and nonsex workers. Vaginal secretions were collected using self-inserted SoftCup, and assayed for cytokines and vaginal microbiome through multiplex ELISA and 16S rRNA sequencing, respectively. Epidemiological data were captured using a validated questionnaire.Results:The median age of participants was 20 years (interquartile range: 18-22 years). Approximately two-thirds of young women (105/168) had vaginal microbial communities characterized by Gardnerella and/or Prevotella spp. dominance; a further 29% (49/168) were predominantly Lactobacillus iners. Microbiome clustering explained a large proportion of cytokine variation (>50% by the first 2 principal components). Age was not associated with vaginal microbial profiles in bivariable or multivariable analyses. Women self-identifying as sex workers had increased alpha (intraindividual) diversity, independent of age, recent sexual activity, HIV, and other sexually transmitted infections (beta = 0.47, 95% confidence interval: 0.05 to 0.90, P = 0.03). Recent sex (number of partners or sex acts last week, time since last vaginal sex) correlated with increased alpha diversity, particularly in participants who were not involved in sex work.Conclusion:Nonoptimal vaginal microbiomes were common in young Kenyan women and associated with sex work and recent sexual activity, but independent of age. Restoring optimal vaginal microflora may represent a useful HIV prevention strategy.
Original language | English (US) |
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Pages (from-to) | 79-87 |
Number of pages | 9 |
Journal | Journal of Acquired Immune Deficiency Syndromes |
Volume | 85 |
Issue number | 1 |
DOIs | |
State | Published - Sep 1 2020 |
Externally published | Yes |
Bibliographical note
Funding Information:The Transitions study was funded by an operating grant (MOP-13044) from the Canadian Institutes of Health Research (CIHR). Biological aspects of the study were funded by the Canadian Institute of Health Research (CIHR), grant numbers TMI 138658 and PJT-148796. A.S. is funded by the European & Developing Countries Clinical Trials Partnership (EDCTP) Career Development Fellowship (TMA2016CDF-1582); S.M. is supported by a CIHR-OHTN New Investigator Award; M.B. and L.R.M. are supported by CIHR New Investigator Awards.
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
Keywords
- HIV
- bacterial vaginosis
- female sex worker
- inflammation
- vaginal microbiome
- young women