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. 2025 Jul 11;231(6):1407-1424.
doi: 10.1093/infdis/jiaf049.

Bacterial Vaginosis Is Associated With Transcriptomic Changes but Not Higher Concentrations of Cervical Leukocytes in a Study of Women at High Risk for Human Immunodeficiency Virus Acquisition

Michelle C Sabo  1 , Salwa Mustafa  1 , Aparajita Saha  1 , Brenda Oyaro  1 , Tina L Fiedler  2 , Melissa Krueger  1 , Esther Fuchs  3 , Marianne Mureithi  4 , Kishor Mandaliya  5 , Walter Jaoko  4 , Barbra A Richardson  2   6   7 , Sina A Gharib  1 , David N Fredricks  1   2 , Javeed A Shah  1   6   8 , R Scott McClelland  1   4   6   9
Affiliations

Bacterial Vaginosis Is Associated With Transcriptomic Changes but Not Higher Concentrations of Cervical Leukocytes in a Study of Women at High Risk for Human Immunodeficiency Virus Acquisition

Michelle C Sabo et al. J Infect Dis. .

Abstract

Background: The association between bacterial vaginosis (BV) and increased human immunodeficiency virus (HIV) acquisition risk may be related to concentrations of HIV-susceptible immune cells in the cervix.

Methods: Participants (31 with BV and 30 with normal microbiota) underwent cervical biopsy at a single visit. Immune cells were quantified and sorted using flow cytometry (n = 55), localization assessed by immunofluorescence (n = 16), and function determined by bulk RNA sequencing (RNA-seq) of live CD45+ cells (n = 21).

Results: Linear regression analyses demonstrated no differences in mean log2 (cells/mg tissue) between women with BV versus normal microbiota for antigen-presenting cell (APC) subtypes linked to HIV risk (including CD1a+HLA-DR+ Langerhans cells, CD11c+CD14+ dendritic cells [DCs], and CD11c+HLA-DR+ DCs) and CD4+ T cells. Women with BV had a higher median proportion of CD11c+HLA-DR+ APCs (out of total cells) in cervical epithelium (0.1% vs 0.0%; P = .03 using Mann-Whitney test). RNA-seq identified 1032 differentially expressed genes (adjusted P < .05) in CD45+ cells between women with BV versus normal microbiota. Women with BV demonstrated downregulation of pathways linked to translation, metabolism, cell stress, and immune signaling.

Conclusions: BV alters immune cell localization and function; future studies are needed to address how these changes may mediate HIV acquisition risk.

Keywords: HIV; bacterial vaginosis; dendritic cell; female reproductive tract; microbiome.

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Conflict of interest statement

Potential conflicts of interest. R. S. M. receives research funding and sexually transmitted infection testing supplies, paid to the University of Washington, from Hologic Corporation. B. A. R. receives honoraria from Gilead for serving on data and safety monitoring boards. D. N. F. and T. L. F. have received royalties from BD. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

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