title: Lactobacillus-dominated cervicovaginal microbiota associated with reduced HIV/STI prevalence and genital HIV viral load in African women.
abstract: Cervicovaginal microbiota not dominated by lactobacilli may facilitate transmission of HIV and other sexually transmitted infections (STIs), as well as miscarriages, preterm births and sepsis in pregnant women. However, little is known about the exact nature of the microbiological changes that cause these adverse outcomes. In this study, cervical samples of 174 Rwandan female sex workers were analyzed cross-sectionally using a phylogenetic microarray. Furthermore, HIV-1 RNA concentrations were measured in cervicovaginal lavages of 58 HIV-positive women among them. We identified six microbiome clusters, representing a gradient from low semi-quantitative abundance and diversity dominated by Lactobacillus crispatus (cluster R-I, with R denoting 'Rwanda') and L. iners (R-II) to intermediate (R-V) and high abundance and diversity (R-III, R-IV and R-VI) dominated by a mixture of anaerobes, including Gardnerella, Atopobium and Prevotella species. Women in cluster R-I were less likely to have HIV (P=0.03), herpes simplex virus type 2 (HSV-2; P<0.01), and high-risk human papillomavirus (HPV; P<0.01) and had no bacterial STIs (P=0.15). Statistically significant trends in prevalence of viral STIs were found from low prevalence in cluster R-I, to higher prevalence in clusters R-II and R-V, and highest prevalence in clusters R-III/R-IV/R-VI. Furthermore, only 10% of HIV-positive women in clusters R-I/R-II, compared with 40% in cluster R-V, and 42% in clusters R-III/R-IV/R-VI had detectable cervicovaginal HIV-1 RNA (Ptrend=0.03). We conclude that L. crispatus-dominated, and to a lesser extent L. iners-dominated, cervicovaginal microbiota are associated with a lower prevalence of HIV/STIs and a lower likelihood of genital HIV-1 RNA shedding.
authors.affiliation: Amsterdam Institute for Global Health and Development (AIGHD) and Department of Global Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Hanneke
authors.initials: H
authors.lastname: Borgdorff
authors.affiliation: TNO Microbiology and Systems Biology, Zeist, The Netherlands.
authors.forename: Evgeni
authors.initials: E
authors.lastname: Tsivtsivadze
authors.affiliation: International Center for Reproductive Health (ICRH), Ghent University, Ghent, Belgium.
authors.forename: Rita
authors.initials: R
authors.lastname: Verhelst
authors.affiliation: Laboratory of Microbial Ecology and Technology (LabMET), Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium.
authors.forename: Massimo
authors.initials: M
authors.lastname: Marzorati
authors.affiliation: Laboratory of Clinical Virology, Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Jurriaans
authors.affiliation: Rinda Ubuzima, Kigali, Rwanda.
authors.forename: Gilles F
authors.initials: GF
authors.lastname: Ndayisaba
authors.affiliation: TNO Microbiology and Systems Biology, Zeist, The Netherlands.
authors.forename: Frank H
authors.initials: FH
authors.lastname: Schuren
authors.affiliation: 1] Amsterdam Institute for Global Health and Development (AIGHD) and Department of Global Health, Academic Medical Center, Amsterdam, The Netherlands [2] Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
authors.forename: Janneke H H M
authors.initials: JH
authors.lastname: van de Wijgert
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000382:microbiology* / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology* / Q000821:virology; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007778:Lactobacillus / Q000235:genetics / Q000302:isolation & purification*; D064307:Microbiota; D008875:Middle Aged; D010802:Phylogeny; D011247:Pregnancy; D015995:Prevalence; D012432:Rwanda; D015231:Sexually Transmitted Diseases, Bacterial / Q000453:epidemiology; D015229:Sexually Transmitted Diseases, Viral / Q000453:epidemiology; D014621:Vagina / Q000382:microbiology* / Q000821:virology; D019562:Viral Load; D055815:Young Adult