Lactobacillus-Deficient Cervicovaginal Bacterial Communities Are Associated with Increased HIV Acquisition in Young South African Women
Open accessAbstract
Elevated inflammation in the female genital tract is associated with increased HIV risk. Cervicovaginal bacteria modulate genital inflammation; however, their role in HIV susceptibility has not been elucidated. In a prospective cohort of young, healthy South African women, we found that individuals with diverse genital bacterial communities dominated by anaerobes other than Gardnerella were at over 4-fold higher risk of acquiring HIV and had increased numbers of activated mucosal CD4+ T cells compared to those with Lactobacillus crispatus-dominant communities. We identified specific bacterial taxa linked with reduced (L. crispatus) or elevated (Prevotella, Sneathia, and other anaerobes) inflammation and HIV infection and found that high-risk bacteria increased numbers of activated genital CD4+ T cells in a murine model. Our results suggest that highly prevalent genital bacteria increase HIV risk by inducing mucosal HIV target cells. These findings might be leveraged to reduce HIV acquisition in women living in sub-Saharan Africa.
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Bacterial vaginosis is more prevalent in women from African, Caribbean, and Black communities and is consistently associated with a 2-5-fold increase in HIV-1 risk.
“Moreover, the presence of BV, which is more prevalent in women from ACB communities [9–11], has been consistently associated with a 2-5-fold increase in HIV-1 risk [12, 13].”
From Feasibility, safety and tolerability of estrogen and/or probiotics for improving vaginal health in Canadian African, Caribbean, and Black women: A pilot phase 1 clinical trial (2025) · cites this paper as [10]
The Results section on HIV acquisition (page unavailable) reports approximately fourfold higher HIV acquisition among young South African women with high-diversity, low-Lactobacillus communities than among those with L. crispatus-dominant communities. That supports the magnitude and direction of the cited risk association, but the paper does not establish a 2–5-fold risk specifically for diagnosed bacterial vaginosis or show that the association is consistent across populations. The prevalence statement is attached to other citations, not this source. (LLM, conf=0.86)
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- Authors
- Gosmann, C., Anahtar, M. N., Handley, S. A., Farcasanu, M., Abu-Ali, G., Bowman, B. A., Padavattan, N., Desai, C., Droit, L., Moodley, A., Dong, M., Chen, Y., Ismail, N., Ndung’u, T., Ghebremichael, M. S., Wesemann, D. R., Mitchell, C., Dong, K. L., Huttenhower, C., Walker, B. D., Virgin, H. W., & Kwon, D. S.
- Affiliations
- Harvard University (US)
- Washington University in St. Louis (US)
- University of KwaZulu-Natal (ZA)
- Brigham and Women's Hospital (US)
- Massachusetts General Hospital (US)
- Howard Hughes Medical Institute (US)
- Corresponding author
- Kwon, Douglas S.
- ORCID
- Venue
- Immunity
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 46
- Issue
- 1
- Pages
- 29-37
- ISSN
- 1074-7613 (ISSN-L)
- PMC
- PMC5270628
- OpenAlex
- W2571049130
- Cited by
- 696
- References
- 4
- Citations by year
- 2026: 49 · 2025: 75 · 2024: 62 · 2023: 85 · 2022: 82 · 2021: 109 · 2020: 90 · 2019: 65 · 2018: 46 · 2017: 33
- FWCI
- 52.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Immunity (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Howard Hughes Medical Institute
- National Institute of General Medical Sciences (T32GM007753)
- National Institute of Allergy and Infectious Diseases (R01AI113217, R01AI067073, R01AI111918)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK043351)
- Topics
- Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Life Sciences › Immunology and Microbiology › Virology › HIV Research and Treatment
- Keywords
- HIV acquisition, cervicovaginal microbiome, Lactobacillus crispatus, anaerobic bacteria, Gardnerella, Prevotella, Sneathia, genital inflammation, HIV target cells, young women, South Africa, sub-Saharan Africa
- MeSH terms
- Animals, Bacteria, Anaerobic, Cervix Uteri, Female, Flow Cytometry, Humans, Lactobacillus, South Africa, Vagina, Cohort Studies, CD4-Positive T-Lymphocytes, HIV Infections, Prevotella, Mice, Microbiota
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