title: Association of sex work with reduced activation of the mucosal immune system.
abstract: BACKGROUND
  Unprotected intercourse and seminal discharge are powerful activators of the mucosal immune system and are important risk factors for transmission of human immunodeficiency virus (HIV). This study was designed to determine if female sex work is associated with changes in the mucosal immunity.
  
  
  METHODS
  Cervicovaginal lavage and plasma from 122 HIV-uninfected female sex workers (FSW) and 44 HIV-uninfected low-risk non-FSW from the same socioeconomic district of Nairobi were analyzed for evidence of immune activation (IA). The cervico-mononuclear cells (CMC) were analyzed for cellular activation by flow cytometry.
  
  
  RESULTS
  Lower IA was observed in FSW compared to the low-risk women as demonstrated by the lower level of MIP-3α (P < .001), ITAC (P < .001), MIG (p.0001), IL-1α (P < .001), IL-1β (P < .001), IL-1Rα (P = .0002), IL-6 (P < .001), IL-8 (P < .001), IL-10 (P = .01), IP-10 (P = .0001), MDC (P < .001), MIP-1α, (P < .001), MIP-1β (P = .005), MCP-1 (P = .03), and TNF-α (P = .006). Significant differences were noted as early as 1 year following initiation of sex work and increased with duration of sex work.
  
  
  CONCLUSIONS
  This study showed that sex work is associated with important changes in the mucosal immune system. By analyzing chemokine/cytokine levels and CMC activation, we observed a lower mucosal IA in HIV-uninfected FSW compared to low-risk women.
authors.affiliation: Department of Medical Microbiology, University of Manitoba.
authors.forename: Julie
authors.initials: J
authors.lastname: Lajoie
authors.affiliation: Kenyan AIDS Control Program, Nairobi, Kenya.
authors.forename: Makubo
authors.initials: M
authors.lastname: Kimani
authors.affiliation: Department of Medical Microbiology, University of Manitoba Public Health Agency of Canada Department of Community Health Sciences, University of Manitoba.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Plummer
authors.affiliation: Kenyan AIDS Control Program, Nairobi, Kenya.
authors.forename: Francis
authors.initials: F
authors.lastname: Nyamiobo
authors.affiliation: Department of Medicine and Immunology, University of Toronto.
authors.forename: Rupert
authors.initials: R
authors.lastname: Kaul
authors.affiliation: Department of Medical Microbiology, University of Manitoba Kenyan AIDS Control Program, Nairobi, Kenya University of Nairobi Institute for Tropical and Infectious Diseases.
authors.forename: Joshua
authors.initials: J
authors.lastname: Kimani
authors.affiliation: Department of Medical Microbiology, University of Manitoba Department of Community Health Sciences, University of Manitoba Department of Medical Microbiology, University of Nairobi.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Fowke
mesh_terms: D000328:Adult; D000368:Aged; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D006801:Humans; D018928:Immunity, Mucosal; D007963:Leukocytes, Mononuclear / Q000276:immunology*; D008213:Lymphocyte Activation; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry / Q000276:immunology; D060386:Sex Workers; D014621:Vagina / Q000737:chemistry / Q000276:immunology; D055815:Young Adult
chemical_list: D016207:Cytokines
keywords: HESN; HIV; chemokines; cytokines; female genital tract; female sex work; immune activation; immune quiescence