Changes in Vaginal Microbiota and Immune Mediators in HIV-1-Seronegative Kenyan Women Initiating Depot Medroxyprogesterone Acetate.
Changes in Vaginal Microbiota and Immune Mediators in HIV-1-Seronegative Kenyan Women Initiating Depot Medroxyprogesterone Acetate.
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DOI：
10.1097/qai.0000000000000866
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发表时间：
2016-04-01
期刊：
影响因子：
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通讯作者：
McClelland RS
中科院分区：
文献类型：
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作者：
Roxby AC;Fredricks DN;Odem-Davis K;Ásbjörnsdóttir K;Masese L;Fiedler TL;De Rosa S;Jaoko W;Kiarie JN;Overbaugh J;McClelland RS
醋酸甲羟孕酮（DMPA）与HIV感染有关。我们研究了DMPA开始后阴道微生物群和炎症环境的变化。在一组HIV阴性的肯尼亚妇女中，我们收集了DMPA前后1年的每月阴道拭子。采用定量PCR技术比较了卷曲乳杆菌、L. jensenii湖葡萄球菌、阴道加德纳菌和总细菌载量（16 S rRNA基因水平）。用ELISA法测定6种阴道免疫介质。通过logistic和线性混合效应回归估计细菌检测和数量的趋势。从2010年至2012年，15名艾滋病毒血清反应阴性的妇女启动了DMPA，提供了85次就诊（中位数为6次就诊/妇女（范围3-8））。DMPA暴露随访的中位时间为8.4个月（范围1.5-11.6）。7名妇女（46%）在DMPA开始前70天内患有细菌性阴道病（BV）。在DMPA开始前，13名妇女（87%）检测到惰性乳杆菌，但很少检测到其他乳杆菌。DMPA暴露后，加德纳氏菌每月减少0.21 log 10拷贝/拭子（p=0.01）。DMPA每月总细菌载量下降0.08 log 10拷贝/拭子（p=0.02）。还观察到白细胞介素（IL）-6（p=0.03）、IL-8（p=0.04）和IL-1受体拮抗剂（p<0.001）持续下降。9名女性（60%）患有L。在DMPA后检测到卷曲;这与降低的IL-6（p=<0.01）和IL-8（p=0.02）显著相关。DMPA的启动导致阴道细菌浓度和炎症介质水平的持续变化。进一步的研究是必要的，以概述受DMPA使用影响的阴道微生物群的组成部分，以及对HIV易感性的影响。
Depot-medroxyprogesterone acetate (DMPA) is associated with HIV acquisition. We studied changes in vaginal microbiota and inflammatory milieu after DMPA initiation. In a cohort of HIV-negative Kenyan women, we collected monthly vaginal swabs over 1 year pre- and post-DMPA. Using quantitative PCR, we compared quantities of Lactobacillus crispatus, L. jensenii, L. iners, Gardnerella vaginalis, and total bacterial load (16S rRNA gene levels). Six vaginal immune mediators were measured with ELISA. Trends in detection and quantity of bacteria were estimated by logistic and linear mixed-effects regression. From 2010-2012, 15 HIV-seronegative women initiated DMPA, contributing 85 visits (median 6 visits/woman (range 3-8)). The median time of DMPA-exposed follow-up was 8.4 months (range 1.5-11.6). Seven women (46%) had bacterial vaginosis (BV) within 70 days before DMPA start. Lactobacillus iners was detected in 13 women (87%) prior to DMPA start, but other lactobacilli were rarely detected. Gardnerella vaginalis declined by 0.21 log10 copies/swab per month after DMPA exposure (p=0.01). Total bacterial load declined by 0.08 log10 copies/swab per month of DMPA (p=0.02). Sustained declines in interleukin (IL)-6 (p=0.03), IL-8 (p=0.04) and IL-1 receptor antagonist (p<0.001) were also noted. Nine women (60%) had L. crispatus detected post-DMPA; which was significantly correlated with reduced IL-6 (p=<0.01) and IL-8 (p=0.02). Initiation of DMPA led to sustained shifts in vaginal bacterial concentrations and levels of inflammatory mediators. Further studies are warranted to outline components of the vaginal microbiota influenced by DMPA use, and impact on HIV susceptibility.