Hormones, microbes, and PrEP drugs in the female genital tract

Abstract

Introduction: For HIV medications intended for HIV prevention, it is critical to achieve exposures in that will provide reliable protection to the FGT. The female genital tract (FGT) is a complex and heterogenous environment.

Areas covered: We reviewed what is known about drug transport and metabolism specific to female genital tissues. We performed a literature search using key words in PubMed and Google Scholar on articles published inclusive of August 2024. We then discuss the impact of sex steroid hormones and vaginal microbiome on the genital tract pharmacology of drugs used for PrEP.

Expert opinion: Better characterization of FGT pharmacology can improve PrEP options for women. Better models that can fully capture the complexities of the FGT to evaluate pharmacokinetic-pharmacodynamic relationships in the context of the complex microenvironment of the FGT will need to be developed and validated to move the field forward.

Keywords: HIV; drug transporters; female genital tract; metabolism; pharmacology.