Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Nov 27:6:1431306.
doi: 10.3389/frph.2024.1431306. eCollection 2024.

Ecology meets reproductive medicine in HIV prevention: the case for geography-informed approaches for bacterial vaginosis in Africa

Jo-Ann S Passmore  1   2   3 , Sinaye Ngcapu  3 , Serah Gitome  4 , Brian R Kullin  1 , Kirsten Welp  1 , Darren P Martin  1 , Disebo Potloane  3 , Monalisa T Manhanzva  1 , Moses M Obimbo  5 , Katherine Gill  1   6 , Mellissa Le Fevre  6 , Anna-Ursula Happel  1   7 , Heather B Jaspan  1   7   8 , Margaret Kasaro  9   10   11 , Elizabeth A Bukusi  4   12
Affiliations
Review

Ecology meets reproductive medicine in HIV prevention: the case for geography-informed approaches for bacterial vaginosis in Africa

Jo-Ann S Passmore et al. Front Reprod Health. .

Abstract

Purpose of review: Women in Africa bear the burden of the HIV epidemic, which has been associated with the high prevalence of bacterial vaginosis (BV) in the region. However, little progress has been made in finding an effective cure for BV. Drawing on advances in microbiome-directed therapies for gastrointestinal disorders, similar live-biotherapeutic based approaches for BV treatment are being evaluated. Here, we summarize current knowledge regarding vaginal microbiota in BV, explore geographical differences in vaginal microbiota, and argue that novel BV therapeutics should be tailored specifically to meet the needs of African women.

Recent findings: Cervicovaginal microbiota dominated by Lactobacillus crispatus are optimal, although these are uncommon in African women. Besides socio-behavioural and environmental influences on the vaginal microbiota, host and microbial genetic traits should be considered, particularly those relating to glycogen metabolism. Novel microbiome-directed approaches being developed to treat BV should employ transfers of multiple microbial strains to ensure sustained colonization and BV cure.

Summary: Improving the efficacy and durability of BV treatment with microbiome-directed therapies by appropriately accounting for host and microbial genetic factors, could potentially reduce the risk of HIV infection in African women.

Keywords: Africa; HIV; bacterial vaginosis; female; geography; host genetics; inflammation; probiotics.

PubMed Disclaimer

Conflict of interest statement

J-AP is receiving funding from the Bill and Melinda Gates Foundation Calestous Juma Scientific Leadership Fellowship, for a project entitled “Vaginal Microbiome Research Consortium (VMRC)-4-Africa” (INV-037612) to characterize Lactobacillus crispatus isolates, in part for development of regionally responsive live-biotherapeutic products for women in Africa. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Proportion of publicly available whole genome sequences of Lactobacillaceae (n = 3084) and BV-associated organisms (BV; n = 185), according to (A) region: North America (dark red), Europe (bright red), Asia (deep orange), Oceania (light orange), South America (yellow), and Africa (green). BV-associated organisms included Prevotella spp., Gardnerella spp., and Fannyhessea spp. only. (B) Within Africa, the numbers of Lactobacillaceae genomes (black numbers) and BV-associated organism genomes (red numbers) from different countries are shown.
See this image and copyright information in PMC

References

    1. Chipanta D, Amo-Agyei S, Giovenco D, Estill J, Keiser O. Socioeconomic inequalities in the 90-90-90 target, among people living with HIV in 12 Sub-Saharan African countries - implications for achieving the 95-95-95 target - analysis of population-based surveys. EClinicalMedicine. (2022) 53:101652. 10.1016/j.eclinm.2022.101652 - DOI - PMC - PubMed
    1. UNAIDS. Women and girls carry the heaviest HIV burden in sub-Saharan Africa: UNAIDS (2022). Available online at: https://www.unaids.org/en/resources/presscentre/featurestories/2022/marc... (accessed April 9, 2024).
    1. Scorgie F, Khoza N, Delany-Moretlwe S, Velloza J, Mangxilana N, Atujuna M, et al. Narrative sexual histories and perceptions of HIV risk among young women taking PrEP in Southern Africa: findings from a novel participatory method. Soc Sci Med. (2021) 270:113600. 10.1016/j.socscimed.2020.113600 - DOI - PMC - PubMed
    1. Peebles K, Velloza J, Balkus JE, McClelland RS, Barnabas RV. High global burden and costs of bacterial vaginosis: a systematic review and meta-analysis. Sex Transm Dis. (2019) 46(5):304–11. 10.1097/OLQ.0000000000000972 - DOI - PubMed
    1. Cho I, Blaser MJ. The human microbiome: at the interface of health and disease. Nat Rev Genet. (2012) 13(4):260–70. 10.1038/nrg3182 - DOI - PMC - PubMed

LinkOut - more resources