Aida Sivro 1 2, Ruth Mwatelah 2, Cheli Kambaran 2, Henok Gebrebrhan 2, Michael G Becker 3, Huiting Ma 4 5, Nichole R Klatt 6 7, Alexander S Zevin 7, Nzioki King’ola 8, Sammy Wambua 8, Peter Gichangi 8, Eve Cheuk 9, Paul J McLaren 2 3, Sharmistha Mishra 3 4, Marissa Becker 2 9, Lyle R McKinnon 1 2 3 10
Affiliations
- 1Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
- 2Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada.
- 3JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
- 4Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
- 5MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
- 6Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, FL.
- 7Department of Pharmaceutics, University of Washington, Seattle, WA.
- 8International Centre for Reproductive Health, Mombasa, Kenya.
- 9Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada; and.
- 10Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
PMID: 32433252
DOI: 10.1097/QAI.0000000000002406
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.
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