The vaginal microbiota of HIV -infected pregnant women: associations with local inflammation and gestational age at delivery C Short1, R Quinlan1, R Brown1, Y Lee1, R Shattock1, P Bennett1, G Taylor1, D MacIntyre1 and London HIV Pregnancy Research Group 1Imperial College London
HIV + women experience high rates of PTB, in spite this, there is little data on their vaginal microbiota during pregnancy. We sought to describe the microbiome in a group of HIV+ pregnant women and explore associations with local cytokine environment and gestational age at delivery (GA).
A prospective observational multi-site study. Vaginal and cervicovaginal fluid (CVF) were obtained using a swab and menstrual softcup during the 2nd trimester from HIV+ and HIV- pregnant women (Exclusion criteria: <350 cells/mm3, multiple or in-vitro pregnancy and injecting drug user). MiSeq sequencing of 16S rRNA gene amplicons was used to characterize the vaginal microbiome. Multiplex assays were used to measure CVF cytokine concentrations. Multivariate modeling was performed to explore associations with bacterial genus/species, CVF cytokine concentrations and clinical data.
HIV+ women (n=53) had a median age of 35, 85% were Black and 14% had PTB. HIV- women (n=30) had a median age of 33 and 50% were Caucasian. HIV+ women delivering at term had higher abundance of Gardnerella (18% versus 3% p=0.003) and Prevotella genera (4% versus 0.1% p=0.002) and lower proportions of Lactobacillus species (70% versus 93% p=0.009) compared to HIV- women. The predominant vaginal community state type (CST) of HIV+ pregnant women was III (L.iners dominant) 55% (n=29), 26% (14) were CST IV (high diversity, anaerobic), 13% (7) were CST I and 2% (1) were CST II. Amongst HIV+ women, PTB was associated with increased proportions of Gardnerella spp. (p<0.0001), Prevotella spp. (p<0.0001), Aerococcus spp. (p=0.015) and Megasphaera spp. (p=0.03) compared with term birth. All PTBs were in women assigned to CST III and IV. The proportion of read counts of CST IV associated anaerobes were positively correlated with CVF IFNγ, IL-1β, IL12p70 and TNFα. IL-1β was positively associated with bacterial diversity and richness. No associations between cytokine concentrations and GA were observed.
Diverse vaginal bacterial communities in HIV+ women are associated with PTB. The associated local proinflammatory cytokine profile may reflect the pathogenic contribution of these organisms to the early trigger of labor.
Funding: Wellcome Trust
Credits: None available.
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