title: Altered vaginal microbiota are associated with perinatal mother-to-child transmission of HIV in African women from Burkina Faso.
abstract: BACKGROUND
  Mother-to-child transmission (MTCT) of HIV remains a significant problem in resource-limited settings, despite the advent of antiretroviral therapies. Because perturbations in vaginal microbial communities are associated with sexual transmission of HIV, we determined whether perinatal MTCT is associated with the vaginal microbiotas of HIV-infected mothers.
  
  
  METHODS
  We conducted a retrospective analysis of cervicovaginal microbiotas by pyrosequencing of bacterial 16S rRNA genes (median 350 sequences per sample) from 10 transmitters and 54 nontransmitters during a perinatal MTCT prevention clinical trial of azidothymidine and the microbicide benzalkonium chloride. Logistic regression was performed adjusting for multiple covariates, including CD4(+) T-cell numbers and treatment group, to correlate abundances of microbial taxa with perinatal MTCT.
  
  
  RESULTS
  The vaginal microbiotas of these subjects were dominated by several lactobacilli species, although a subset of subjects was colonized by diverse anaerobic species. MTCT of HIV was associated with significantly greater relative abundances of several groups of microorganisms. Most notably, among the abundant bacterial species, Gardnerella vaginalis was significantly enriched in cases of antepartum transmission, compared with nontransmission (odds ratio 1.7; P = 0.004). Neither azidothymidine nor benzalkonium chloride treatment was associated with shifts in microbial distributions compared with the placebo control group.
  
  
  CONCLUSIONS
  These data suggest that alterations in vaginal microbial communities are associated with an increased risk for perinatal MTCT, consistent with results with horizontal transmission of HIV. Therefore, determining the mucosal features associated with alterations in vaginal microbial communities may guide efforts to modulate the risk for HIV MTCT.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Colorado School of Medicine, Denver, CO, USA.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Frank
authors.forename: Olivier
authors.initials: O
authors.lastname: Manigart
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Nicolas
authors.initials: N
authors.lastname: Meda
authors.forename: Diane
authors.initials: D
authors.lastname: Valéa
authors.forename: Weiming
authors.initials: W
authors.lastname: Zhang
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Norman R
authors.initials: NR
authors.lastname: Pace
authors.forename: Philippe
authors.initials: P
authors.lastname: Van de Perre
authors.forename: Edward N
authors.initials: EN
authors.lastname: Janoff
mesh_terms: D001483:Base Sequence; D002050:Burkina Faso; D004311:Double-Blind Method; D005260:Female; D005798:Genes, Bacterial; D015658:HIV Infections / Q000150:complications* / Q000382:microbiology / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D054892:Metagenome; D008969:Molecular Sequence Data; D010802:Phylogeny; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology*; D012329:RNA, Bacterial / Q000235:genetics; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012189:Retrospective Studies; D014621:Vagina / Q000382:microbiology*
chemical_list: D012329:RNA, Bacterial; D012336:RNA, Ribosomal, 16S