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Quinn Peters M, Domenjo-Vila E, Carlson M, Armistead B, Edlefsen PT, Gasper M, Dabee S, Whidbey C, Jaspan HB, Prlic M, Harrington WE. A non-invasive method to sample immune cells in the lower female genital tract using menstrual discs. bioRxiv 2024:2023.11.16.567469. [PMID: 38370684 PMCID: PMC10871271 DOI: 10.1101/2023.11.16.567469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
T cells in the human female genital tract (FGT) 2 are key mediators of susceptibility to and protection from infection, including HIV and other sexually transmitted infections. There is a critical need for increased understanding of the distribution and activation of T cell populations in the FGT, but current sampling methods require a healthcare provider and are expensive, limiting the ability to study these populations longitudinally. To address these challenges, we have developed a method to sample immune cells from the FGT utilizing disposable menstrual discs which are non-invasive, self-applied, and low-cost. To demonstrate reproducibility, we sampled the cervicovaginal fluid (CVF) 3 of healthy, reproductive-aged individuals using menstrual discs over three sequential days. CVF was processed for cervicovaginal cells, and high parameter flow cytometry was used to characterize immune populations. We identified large numbers of live, CD45+ leukocytes, as well as distinct populations of T cells and B cells. Within the T cell compartment, activation and suppression status of T cell subsets were consistent with previous studies of the FGT utilizing current approaches, including identification of both tissue resident and migratory populations. In addition, the T cell population structure was highly conserved across days within individuals but divergent across individuals. Our approach to sample immune cells in the FGT with menstrual discs will decrease barriers to participation and empower longitudinal sampling in future research studies.
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Peters MQ, Domenjo-Vila E, Carlson M, Armistead B, Edlefsen PT, Gasper M, Dabee S, Whidbey C, Jaspan HB, Prlic M, Harrington WE. A Noninvasive Method to Sample Immune Cells in the Lower Female Genital Tract Using Menstrual Discs. Immunohorizons 2024; 8:182-192. [PMID: 38386594 PMCID: PMC10916362 DOI: 10.4049/immunohorizons.2300105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
T cells in the human female genital tract (FGT) are key mediators of susceptibility to and protection from infection, including HIV and other sexually transmitted infections. There is a critical need for increased understanding of the distribution and activation of T cell populations in the FGT, but current sampling methods require a healthcare provider and are expensive, limiting the ability to study these populations longitudinally. To address these challenges, we have developed a method to sample immune cells from the FGT utilizing disposable menstrual discs which are noninvasive, self-applied, and low in cost. To demonstrate reproducibility, we sampled the cervicovaginal fluid of healthy, reproductive-aged individuals using menstrual discs across 3 sequential days. Cervicovaginal fluid was processed for cervicovaginal cells, and high-parameter flow cytometry was used to characterize immune populations. We identified large numbers of live, CD45+ leukocytes, as well as distinct populations of T cells and B cells. Within the T cell compartment, activation and suppression status of T cell subsets were consistent with previous studies of the FGT utilizing current approaches, including identification of both tissue-resident and migratory populations. In addition, the T cell population structure was highly conserved across days within individuals but divergent across individuals. Our approach to sample immune cells in the FGT with menstrual discs will decrease barriers to participation and empower longitudinal sampling in future research studies.
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Affiliation(s)
- M. Quinn Peters
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA
| | - Eva Domenjo-Vila
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Marc Carlson
- Research Scientific Computing, Enterprise Analytics, Seattle Children’s Research Institute, Seattle, WA
| | - Blair Armistead
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA
| | - Paul T. Edlefsen
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
| | - Melanie Gasper
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA
| | - Smritee Dabee
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA
| | | | - Heather B. Jaspan
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
| | - Martin Prlic
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
- Department of Immunology, University of Washington, Seattle, WA
| | - Whitney E. Harrington
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA
- Department of Pediatrics, University of Washington, Seattle, WA
- Department of Global Health, University of Washington, Seattle, WA
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Dabee S, Balle C, Onono M, Innes S, Nair G, Palanee-Phillips T, Burgener AD, Bosinger SE, Passmore JAS, Heffron R, Jaspan H, Happel AU. Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections. Curr HIV/AIDS Rep 2023; 20:251-260. [PMID: 37341916 PMCID: PMC10403392 DOI: 10.1007/s11904-023-00662-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE OF REVIEW The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial. RECENT FINDINGS Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.
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Affiliation(s)
- Smritee Dabee
- Center for Global Infectious Disease, Seattle Children’s Research Institute, 307 Westlake Ave. N, Seattle, WA 98109 USA
| | - Christina Balle
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | | | - Steve Innes
- Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, 7915 South Africa
| | - Gonasagrie Nair
- Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, 7915 South Africa
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Klein St & Esselen St, Hillbrow, Johannesburg 2001 South Africa
| | - Adam D. Burgener
- Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106 USA
- Department of Obstetrics and Gynecology, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB R3T 2N2 Canada
- Unit of Infectious Diseases, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital, Visionsgatan 18, L8, 171 76 Solna, Sweden
| | - Steven E. Bosinger
- ENPRC Genomics Core Laboratory, Emory National Primate Research Center, 954 Gatewood Rd NE, Atlanta, GA 30329 USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA 30307 USA
- Emory Vaccine Center, Emory University, 7 1st Ave, Atlanta, GA 30317 USA
| | - Jo-Ann S. Passmore
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- National Health Laboratory Service, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Renee Heffron
- Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, AL 35294-2170 Birmingham, USA
- Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA 98195 USA
| | - Heather Jaspan
- Center for Global Infectious Disease, Seattle Children’s Research Institute, 307 Westlake Ave. N, Seattle, WA 98109 USA
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Department of Pediatrics, University of Washington, 1959 NE Pacific St., Seattle, WA 98195 USA
- Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA 98195 USA
| | - Anna-Ursula Happel
- Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
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Temu TM, Polyak SJ, Wanjalla CN, Mandela NA, Dabee S, Mogaka JN, Masyuko S, Longernecker C, Shakil S, Chohan B, Page ST, Lacourse SM, Gitura B, Crothers K, Oyugi J, Jaspan H, Farquhar C, Zifodya JS. Latent tuberculosis is associated with heightened levels of pro-and anti-inflammatory cytokines among Kenyan men and women living with HIV on long-term antiretroviral therapy. AIDS 2023; 37:1065-1075. [PMID: 36928263 PMCID: PMC10155699 DOI: 10.1097/qad.0000000000003523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/24/2023] [Accepted: 02/09/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Persons with HIV (PWH) on antiretroviral therapy (ART) have persistent immune activation associated with increased risk for non-AIDS related diseases. Latent tuberculosis infection (LTBI), endemic in Africa, may contribute to this immune dysregulation. We evaluated the impact of HIV and TB co-infection on plasma pro- and anti-inflammatory cytokines among Kenyan adults. METHODS We compared data from 221 PWH on long-term ART and 177 HIV-negative adults examining biomarkers of pro-[sCD14, interleukin (IL)-2, IL-6, interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), IL-12p70, IL-17A] and anti(IL-4, IL-5, IL-13) inflammatory cytokines, by HIV/LTBI status (HIV+LTBI+, HIV+LTBI-, HIV-LTBI+, HIV-LTBI-). LTBI was diagnosed based on a positive QuantiFERON TB Gold-Plus test in the absence of active TB symptoms. Linear regression was used to evaluate the associations of HIV, LTBI, and HIV/LTBI status with biomarkers adjusting for clinical factors including HIV-specific factors. RESULTS Half of the participants were women and 52% had LTBI. HIV was independently associated with higher sCD14, IL-15, IL-6, IL-4, IL-5. LTBI was independently associated with higher TNF-α, IL-12p70, IL-17A, IL-4, IL-13 in adjusted models ( P < 0.05). LTBI status was associated with higher IL-4 and IL-12p70 only among PWH, but not HIV-negative participants ( P < 0.05 for interactions). In multivariate analysis, only HIV+LTBI+ demonstrated elevated levels of TNF-α, IL-6, IL-12p70, IL-15, IL-17A, IL4, IL-5, IL-13 in comparison to the HIV-LTBI- ( P < 0.05 for all). The effect of LTBI on cytokines among PWH was independent of CD4 + T-cell count and ART duration. CONCLUSIONS Despite viral suppression, persons with HIV and LTBI exhibit abnormal cytokine production accompanied by high concentrations of pro- and anti-inflammatory cytokines.
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Affiliation(s)
- Tecla M. Temu
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Stephen J. Polyak
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington
| | | | | | - Smritee Dabee
- Center for Infectious Disease Research, Seattle Biomedical Research Institute
| | - Jerusha N. Mogaka
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Chris Longernecker
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington
| | - Saate Shakil
- Department of Medicine, University of Washington
| | - Bhavna Chohan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Sylvia M. Lacourse
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington
| | | | | | - Julius Oyugi
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Heather Jaspan
- Center for Infectious Disease Research, Seattle Biomedical Research Institute
| | - Carey Farquhar
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington
- Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
| | - Jerry S. Zifodya
- Department of Medicine, Tulane University School of Medicine, New Orleans, Lousiana, USA
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Brown BP, Feng C, Tanko RF, Jaumdally SZ, Bunjun R, Dabee S, Happel AU, Gasper M, Nyangahu DD, Onono M, Nair G, Palanee-Phillips T, Scoville CW, Heller K, Baeten JM, Bosinger SE, Burgener A, Passmore JAS, Heffron R, Jaspan HB. Copper intrauterine device increases vaginal concentrations of inflammatory anaerobes and depletes lactobacilli compared to hormonal options in a randomized trial. Nat Commun 2023; 14:499. [PMID: 36717556 PMCID: PMC9886933 DOI: 10.1038/s41467-023-36002-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
Effective contraceptives are a global health imperative for reproductive-aged women. However, there remains a lack of rigorous data regarding the effects of contraceptive options on vaginal bacteria and inflammation. Among 218 women enrolled into a substudy of the ECHO Trial (NCT02550067), we evaluate the effect of injectable intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel implant (LNG), and a copper intrauterine device (Cu-IUD) on the vaginal environment after one and six consecutive months of use, using 16S rRNA gene sequencing and multiplex cytokine assays. Primary endpoints include incident BV occurrence, bacterial diversity, and bacterial and cytokine concentrations. Secondary endpoints are bacterial and cytokine concentrations associated with later HIV seroconversion. Participants randomized to Cu-IUD exhibit elevated bacterial diversity, increased cytokine concentrations, and decreased relative abundance of lactobacilli after one and six months of use, relative to enrollment and other contraceptive options. Total bacterial loads of women using Cu-IUD increase 5.5 fold after six months, predominantly driven by increases in the concentrations of several inflammatory anaerobes. Furthermore, growth of L. crispatus (MV-1A-US) is inhibited by Cu2+ ions below biologically relevant concentrations, in vitro. Our work illustrates deleterious effects on the vaginal environment induced by Cu-IUD initiation, which may adversely impact sexual and reproductive health.
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Affiliation(s)
- Bryan P Brown
- Seattle Children's Research Institute, Seattle, USA.
- University of Washington, Seattle, USA.
| | - Colin Feng
- Seattle Children's Research Institute, Seattle, USA
| | - Ramla F Tanko
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Shameem Z Jaumdally
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Rubina Bunjun
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Seattle Children's Research Institute, Seattle, USA
- University of Washington, Seattle, USA
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna-Ursula Happel
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Melanie Gasper
- Seattle Children's Research Institute, Seattle, USA
- University of Washington, Seattle, USA
| | - Donald D Nyangahu
- Seattle Children's Research Institute, Seattle, USA
- University of Washington, Seattle, USA
| | | | | | | | | | | | - Jared M Baeten
- University of Washington, Seattle, USA
- Gilead Sciences, Inc, Seattle, USA
| | - Steven E Bosinger
- Yerkes National Primate Research Center, Atlanta, USA
- Emory University, Atlanta, USA
| | - Adam Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, USA
- University of Manitoba, Winnipeg, Canada
- Karolinska Institute, Stockholm, Sweden
| | - Jo-Ann S Passmore
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Renee Heffron
- University of Washington, Seattle, USA
- University of Alabama, Birmingham, USA
| | - Heather B Jaspan
- Seattle Children's Research Institute, Seattle, USA.
- University of Washington, Seattle, USA.
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
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6
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Delgado-Diaz DJ, Jesaveluk B, Hayward JA, Tyssen D, Alisoltani A, Potgieter M, Bell L, Ross E, Iranzadeh A, Allali I, Dabee S, Barnabas S, Gamieldien H, Blackburn JM, Mulder N, Smith SB, Edwards VL, Burgener AD, Bekker LG, Ravel J, Passmore JAS, Masson L, Hearps AC, Tachedjian G. Lactic acid from vaginal microbiota enhances cervicovaginal epithelial barrier integrity by promoting tight junction protein expression. Microbiome 2022; 10:141. [PMID: 36045402 PMCID: PMC9429363 DOI: 10.1186/s40168-022-01337-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 07/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Women with a cervicovaginal microbiota dominated by Lactobacillus spp. are at reduced risk of acquiring sexually transmitted infections including HIV, but the biological mechanisms involved remain poorly defined. Here, we performed metaproteomics on vaginal swab samples from young South African women (n = 113) and transcriptomics analysis of cervicovaginal epithelial cell cultures to examine the ability of lactic acid, a metabolite produced by cervicovaginal lactobacilli, to modulate genital epithelial barrier function. RESULTS Compared to women with Lactobacillus-depleted microbiota, women dominated by vaginal lactobacilli exhibit higher abundance of bacterial lactate dehydrogenase, a key enzyme responsible for lactic acid production, which is independently associated with an increased abundance of epithelial barrier proteins. Physiological concentrations of lactic acid enhance epithelial cell culture barrier integrity and increase intercellular junctional molecule expression. CONCLUSIONS These findings reveal a novel ability of vaginal lactic acid to enhance genital epithelial barrier integrity that may help prevent invasion by sexually transmitted pathogens. Video abstract.
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Affiliation(s)
- David Jose Delgado-Diaz
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia
| | - Brianna Jesaveluk
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia
| | - Joshua A Hayward
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia
| | - David Tyssen
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Arghavan Alisoltani
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA, 92521, USA
| | - Matthys Potgieter
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Liam Bell
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Elizabeth Ross
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Arash Iranzadeh
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Imane Allali
- Laboratory of Human Pathologies Biology, Department of Biology, Faculty of Sciences, Mohammed V University in Rabat, 1014, Rabat, Morocco
| | - Smritee Dabee
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, 98101, USA
| | - Shaun Barnabas
- Family Centre for Research with Ubuntu, Stellenbosch University, Cape Town, 7505, South Africa
| | - Hoyam Gamieldien
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Jonathan M Blackburn
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for Infectious Diseases Research (CIDRI) in Africa Wellcome Trust Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Steven B Smith
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Vonetta L Edwards
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Adam D Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, OH, 44106, USA
- Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Jacques Ravel
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jo-Ann S Passmore
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa
- National Health Laboratory Service, Cape Town, 7925, South Africa
| | - Lindi Masson
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa
- Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Anna C Hearps
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia
- Central Clinical School, Monash University, Melbourne, 3004, Australia
| | - Gilda Tachedjian
- Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, VIC, 3004, Australia.
- Department of Microbiology, Monash University, Clayton, VIC, 3168, Australia.
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, 3010, Australia.
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7
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Bunjun R, Ramla TF, Jaumdally SZ, Noël-Romas L, Ayele H, Brown BP, Gamieldien H, Harryparsad R, Dabee S, Nair G, Onono M, Palanee-Phillips T, Scoville CW, Heller KB, Baeten JM, Bosinger SE, Burgener A, Passmore JAS, Jaspan H, Heffron R. Initiating Intramuscular Depot Medroxyprogesterone Acetate Increases Frequencies of Th17-like Human Immunodeficiency Virus Target Cells in the Genital Tract of Women in South Africa: A Randomized Trial. Clin Infect Dis 2022; 75:2000-2011. [PMID: 35941737 PMCID: PMC9710690 DOI: 10.1093/cid/ciac284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Cervicovaginal CD4+ T cells are preferential targets for human immunodeficiency virus (HIV) infection and have consequently been used as a proxy measure for HIV susceptibility. The ECHO randomized trial offered a unique opportunity to consider the association between contraceptives and Th17-like cells within a trial designed to evaluate HIV risk. In a mucosal substudy of the ECHO trial, we compared the impact of initiating intramuscular depot medroxyprogesterone acetate (DMPA-IM), copper-IUD, and the levonorgestrel (LNG) implant on cervical T cells. METHODS Cervical cytobrushes from 58 women enrolled in the ECHO trial were collected at baseline and 1 month after contraceptive initiation. We phenotyped cervical T cells using multiparameter flow cytometry, characterized the vaginal microbiome using 16s sequencing, and determined proteomic signatures associated with Th17-like cells using mass spectrometry. RESULTS Unlike the LNG implant or copper-IUD, DMPA-IM was associated with higher frequencies of cervical Th17-like cells within 1 month of initiation (P = .012), including a highly susceptible, activated population co-expressing CD38, CCR5, and α4β7 (P = .003). After 1 month, women using DMPA-IM also had more Th17-like cells than women using the Cu-IUD (P = .0002) or LNG implant (P = .04). Importantly, in women using DMPA-IM, proteomic signatures signifying enhanced mucosal barrier function were associated with the increased abundance of Th17-like cells. We also found that a non-Lactobacillus-dominant microbiome at baseline was associated with more Th17-like cells post-DMPA-IM (P = .03), although this did not influence barrier function. CONCLUSIONS Our data suggest that DMPA-IM-driven accumulation of HIV-susceptible Th17-like cells might be counteracted by their role in maintaining mucosal barrier integrity. CLINICAL TRIALS REGISTRATION NCT02550067.
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Affiliation(s)
- Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Tanko F Ramla
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Laura Noël-Romas
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA,Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada
| | - Hossaena Ayele
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Bryan P Brown
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Hoyam Gamieldien
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Rushil Harryparsad
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute (WHRI), Johannesburg, South Africa,University of Washington, Seattle, Washington, USA
| | | | | | | | - Steven E Bosinger
- Emory University, Atlanta, Georgia, USA,Yerkes National Primate Research Center, Atlanta, Georgia, USA
| | - Adam Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA,Department of Obstetrics and Gynecology, University of Manitoba, Winnipeg, Canada,Unit of Infectious Diseases, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Jo-Ann S Passmore
- Correspondence: J.-A. S. Passmore, Institute of Infectious Disease and Molecular Medicine, Division of Virology, Faculty of Health Sciences, University of Cape Town, Observatory 7925, South Africa ()
| | - Heather Jaspan
- Institute of Infectious Disease and Molecular Medicine, Department of Pathology, University of Cape Town, Cape Town, South Africa,Seattle Children’s Research Institute, Seattle, Washington, USA,University of Washington, Seattle, Washington, USA
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8
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Laher F, Richardson SI, Smith P, Sullivan PS, Abrahams AG, Asowata OE, Bitangumutwenzi P, Dabee S, Dollah A, Fernandez N, Langat RK, Bose DL, Likhitwonnawut U, Mullick R, Resop RS, Sutar J, Thompson-Hall A“N, Traeger MW, Tuyishime M, Wambui J, Bekker LG, Kaleebu P, McCormack S, O'Connor DH, Warren M, Torri T, Thyagarajan B. HIV Prevention in a Time of COVID-19: A Report from the HIVR4P // Virtual Conference 2021. AIDS Res Hum Retroviruses 2022; 38:350-358. [PMID: 34714100 PMCID: PMC9131040 DOI: 10.1089/aid.2021.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The HIV Research for Prevention (HIVR4P) conference catalyzes knowledge sharing on biomedical HIV prevention interventions such as HIV vaccines, antibody infusions, pre-exposure prophylaxis, and microbicides in totality-from the molecular details and delivery formulations to the behavioral, social, and structural underpinnings. HIVR4P // Virtual was held over the course of 2 weeks on January 27-28 and February 3-4, 2021 as the coronavirus disease 2019 (COVID-19) pandemic continued to inflict unprecedented harm globally. The HIVR4P community came together with 1,802 researchers, care providers, policymakers, implementers, and advocates from 92 countries whose expertise spanned the breadth of the HIV prevention pipeline from preclinical to implementation. The program included 113 oral and 266 poster presentations. This article presents a brief summary of the conference highlights. Complete abstracts, webcasts, and daily rapporteur summaries may be found on the conference website (https://www.hivr4p.org/).
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Affiliation(s)
- Fatima Laher
- University of the Witwatersrand, Johannesburg, South Africa
| | - Simone I. Richardson
- University of the Witwatersrand, Johannesburg, South Africa
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Philip Smith
- The Desmond Tutu HIV Research Centre, Cape Town, South Africa
| | | | | | | | | | - Smritee Dabee
- Seattle Children's Research Institute, Seattle, Washington, USA
| | | | | | | | - Devi Leena Bose
- International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | | | - Ranajoy Mullick
- International AIDS Vaccine Initiative (IAVI), New Delhi, India
| | - Rachel S. Resop
- The George Washington University, Washington, District of Columbia, USA
| | - Jyoti Sutar
- Indian Council of Medical Research (ICMR), Mumbai, India
| | | | | | | | - Jacque Wambui
- AFROCAB Treatment Access Partnerships, Nairobi, Kenya
| | | | - Pontiano Kaleebu
- Uganda Virus Research Institute & MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
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9
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Happel AU, Gasper M, Balle C, Konstantinus I, Gamieldien H, Dabee S, Gill K, Bekker LG, Passmore JAS, Jaspan HB. Persistent, Asymptomatic Colonization with Candida is Associated with Elevated Frequencies of Highly Activated Cervical Th17-Like Cells and Related Cytokines in the Reproductive Tract of South African Adolescents. Microbiol Spectr 2022; 10:e0162621. [PMID: 35348351 PMCID: PMC9045181 DOI: 10.1128/spectrum.01626-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 02/25/2022] [Indexed: 11/20/2022] Open
Abstract
Cervicovaginal inflammation, nonoptimal microbiota, T-cell activation, and hormonal contraceptives may increase HIV risk, yet associations between these factors and subclinical Candida colonization or hyphae are unknown. We collected cervicovaginal samples from 94 South African adolescents, aged 15 to 19 years, who were randomized to injectable norethisterone enanthate (Net-En), an etonorgesterol/ethinyl estradiol vaginal ring (NuvaRing), or oral contraceptives in the UChoose trial (NCT02404038) at baseline and 16 weeks post-randomization. We assessed cervicovaginal samples for subclinical Candida colonization (by quantitative PCR [qPCR]), hyphae (by Gram stain), microbiota composition (by 16S rRNA gene sequencing), cytokine concentrations (by Luminex), and cervical T-cell phenotypes and activation (by multiparameter flow cytometry). While hormonal contraceptive type did not influence incidence of Candida colonization or hyphae, hyphae presence was associated with significantly elevated concentrations of IL-22, IL-17A and IL-17F, all produced by Th17 cells, but not of other cytokines, such as IL-1β or IL-6, after adjustment for confounders. Subclinical Candida colonization was associated with reduced frequencies of Th17-like cells and elevated frequencies of CCR6-CCR10 T cells. Women with Candida hyphae were less likely to have bacterial vaginosis (BV). Persistent, subclinical colonization with Candida over 16 weeks was associated with significant increases in Th17-related cytokine concentrations and highly activated Th17-like and CCR6-CCR10 T-cell frequencies. These data suggest that vaginal Candida colonization and hyphae increase Th17-related cytokines, but not overall female genital tract inflammation in Sub-Saharan African adolescents. Persistent Candida colonization, even when asymptomatic, may increase Th17 cell frequencies and related cytokines and thereby could subsequently increase HIV risk, although the causal relationship requires confirmation. IMPORTANCE Sub-Saharan African female adolescents are globally at the highest risk of HIV acquisition, and genital inflammation, microbial dysbiosis, and cervical HIV target cell activation are thought to contribute to this risk. Previously, the relationship between these mucosal factors and subclinical vaginal Candida colonization or hyphae has not been described, and the role of HIV-susceptible Th17 cells in mediating anti-Candida immunity in the human female genital tract has not been clearly established. We show that presence of yeast hyphae was associated with increases in Th17 cell-related cytokines and the absence of microbial dysbiosis, and that persistent Candida colonization resulted in significant increases in Th17-related cytokines and highly activated Th17-like cell frequencies. Our results suggest that Th17 cells are important for anti-Candida immunity in the human female genital tract and that prolonged vaginal Candida colonization may contribute to increased HIV risk in Sub-Saharan African adolescents by increasing HIV target cell frequencies and activation.
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Affiliation(s)
- Anna-Ursula Happel
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Melanie Gasper
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Christina Balle
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Iyaloo Konstantinus
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Namibia Institute of Pathology, Windhoek, Namibia
| | - Hoyam Gamieldien
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Seattle Children’s Research Institute, Seattle, Washington, USA
| | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- DST-NRF CAPRISA Centre of Excellence in HIV Prevention, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Heather B. Jaspan
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Seattle Children’s Research Institute, Seattle, Washington, USA
- Department of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
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10
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Tanko RF, Bunjun R, Dabee S, Jaumdally SZ, Onono M, Nair G, Palanee-Phillips T, Harryparsad R, Happel AU, Gamieldien H, Qumbelo Y, Sinkala M, Scoville CW, Heller K, Baeten JM, Bosinger SE, Burgener A, Heffron R, Jaspan HB, Passmore JAS. The Effect Of Contraception On Genital Cytokines In Women Randomized To Copper Intrauterine Device, Intramuscular Depot Medroxyprogesterone Acetate Or Levonorgestrel Implant. J Infect Dis 2022; 226:907-919. [PMID: 35263421 PMCID: PMC9470113 DOI: 10.1093/infdis/jiac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The ECHO Trial randomized women to intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel implant (LNG-implant), or copper intrauterine device (Cu-IUD). In a sub-study of the ECHO Trial, we tested the hypothesis that contraceptives influence genital inflammation by comparing cervicovaginal cytokine changes following contraception initiation. In addition, we compared cytokine profiles in women who acquired HIV (cases) versus those remaining HIV-negative (controls). METHODS Women (n=251) from South Africa and Kenya were included. Twenty-seven cervicovaginal cytokines were measured by Luminex at baseline, 1- and 6-month post-contraceptive initiation. In addition, cytokines were measured pre-seroconversion in HIV cases (n=25) and controls (n=100). RESULTS At 6-months post-contraceptive initiation, women using Cu-IUD had increased concentrations of 25/27 cytokines compared to their respective baseline concentrations. In contrast, women initiating DMPA-IM and LNG-implant did not experience changes in cervicovaginal cytokines. Pre-seroconversion concentrations of IL-1β, IL-6, and TNF-α, previously associated with HIV risk, correlated with increased HIV risk in a logistic regression analysis, although not significantly after correcting for multiple comparisons. Adjusting for contraceptive arm did not alter these results. CONCLUSION Although Cu-IUD use broadly increased cervicovaginal cytokine concentrations at 6-months post-insertion, these inflammatory changes were found not to be a significant driver of HIV risk.
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Affiliation(s)
- Ramla F Tanko
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Rushil Harryparsad
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Anna-Ursula Happel
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Hoyam Gamieldien
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Yamkela Qumbelo
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | - Musalula Sinkala
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa
| | | | | | - Jared M Baeten
- University of Washington, Seattle, USA.,Gilead Sciences, Foster City, USA
| | - Steven E Bosinger
- Emory University, Atlanta, USA.,Yerkes National Primate Research Center, Atlanta, USA
| | - Adam Burgener
- Center for Global Health and Diseases, Case Western Reserve University, Ohio, USA.,Department of Obstetrics & Gynecology and Medical Microbiology, University of Manitoba, Canada.,Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Heather B Jaspan
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,Seattle Children's Research Institute, Seattle, USA
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), Department of Pathology, University of Cape Town, South Africa.,NRF-DST CAPRISA Centre of Excellence in HIV Prevention, Durban, South Africa.,National Health Laboratory Service, Cape Town, South Africa
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11
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Alisoltani A, Manhanzva MT, Potgieter M, Balle C, Bell L, Ross E, Iranzadeh A, du Plessis M, Radzey N, McDonald Z, Calder B, Allali I, Mulder N, Dabee S, Barnabas S, Gamieldien H, Godzik A, Blackburn JM, Tabb DL, Bekker LG, Jaspan HB, Passmore JAS, Masson L. Correction to: Microbial function and genital inflammation in young South African women at high risk of HIV infection. Microbiome 2022; 10:42. [PMID: 35264249 PMCID: PMC8905787 DOI: 10.1186/s40168-022-01245-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Arghavan Alisoltani
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA, 92521, USA
| | - Monalisa T Manhanzva
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Matthys Potgieter
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Christina Balle
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Liam Bell
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Elizabeth Ross
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Arash Iranzadeh
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | | | - Nina Radzey
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Zac McDonald
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Bridget Calder
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Imane Allali
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Laboratory of Human Pathologies Biology, Department of Biology and Genomic Center of Human Pathologies, Mohammed V University, Rabat, Morocco
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for Infectious Diseases Research (CIDRI) in Africa Wellcome Trust Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Smritee Dabee
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Seattle Children's Research Institute, University of Washington, Seattle, WA, 98101, USA
| | - Shaun Barnabas
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Hoyam Gamieldien
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Adam Godzik
- Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA, 92521, USA
| | - Jonathan M Blackburn
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
| | - David L Tabb
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Stellenbosch, 7602, South Africa
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Stellenbosch, 7602, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Heather B Jaspan
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Seattle Children's Research Institute, University of Washington, Seattle, WA, 98101, USA
| | - Jo-Ann S Passmore
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa
- National Health Laboratory Service, Cape Town, 7925, South Africa
| | - Lindi Masson
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa.
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa.
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa.
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Central Clinical School, Monash University, Melbourne, 3004, Australia.
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12
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Dabee S, Tanko RF, Brown BP, Bunjun R, Balle C, Feng C, Konstantinus IN, Jaumdally SZ, Onono M, Nair G, Palanee-Phillips T, Gill K, Baeten JM, Bekker LG, Passmore JAS, Heffron R, Jaspan HB, Happel AU. Comparison of Female Genital Tract Cytokine and Microbiota Signatures Induced by Initiation of Intramuscular DMPA and NET-EN Hormonal Contraceptives - a Prospective Cohort Analysis. Front Immunol 2021; 12:760504. [PMID: 34956191 PMCID: PMC8696178 DOI: 10.3389/fimmu.2021.760504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/22/2021] [Indexed: 01/17/2023] Open
Abstract
Background Cervicovaginal inflammation, bacterial microbiota and hormonal contraceptives all influence sexual and reproductive health. To date, the effects of intramuscular depo-medroxyprogesterone acetate (DMPA-IM) versus injectable norethisterone enanthate (NET-EN) on vaginal microbiota or cytokines have not been compared back-to-back, although in-vitro data suggest that DMPA-IM and NET-EN have different pharmacokinetic and biologic activities. This study aimed at comparing the effects of DMPA-IM versus NET-EN initiation on cervicovaginal cytokines and microbiota in women at high risk for sexually transmitted infections (STIs) assigned to the respective contraceptives. Methods We collected socio-demographic characteristics and vaginal samples from women initiating DMPA-IM (ECHO Trial; n = 53) and NET-EN (UChoose Trial; n = 44) at baseline and after two consecutive injections to assess cytokine concentrations by Luminex, vaginal microbiota by 16S rRNA gene sequencing, STIs, bacterial vaginosis (BV) and candidiasis. Results Cytokine concentrations did not change significantly after initiating DMPA-IM or NET-EN, although NET-EN versus DMPA-IM-associated profiles were distinct. While the abundance of bacterial taxa associated with optimal and non-optimal microbiota fluctuated with DMPA-IM use, overall community composition did not significantly change with either contraceptive. HSV-2 serology, chlamydial infection, gonorrhoea and candidiasis did not influence the associations between contraceptive type and cervicovaginal cytokines or microbiota. Conclusions Both DMPA-IM and NET-EN use did not lead to broad inflammatory or microbiota changes in the female genital tract of sub-Saharan African women. This suggests that NET-EN is likely a viable option for contraception in African women at high risk of BV and STIs.
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Affiliation(s)
- Smritee Dabee
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Ramla F. Tanko
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA) Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa,The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies (IMPM), Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
| | - Bryan P. Brown
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | - Rubina Bunjun
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Christina Balle
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Colin Feng
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States
| | | | - Shameem Z. Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | | | | | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States,Gilead Sciences, Foster City, CA, United States
| | | | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Centre for the AIDS Programme of Research in South Africa (CAPRISA) Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa,National Health Laboratory Service, Cape Town, South Africa
| | - Renee Heffron
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Heather B. Jaspan
- Center for Global Infectious Disease, Seattle Children’s Research Institute, Seattle, WA, United States,Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa,Department of Global Health, University of Washington, Seattle, WA, United States,*Correspondence: Heather B. Jaspan,
| | - Anna-Ursula Happel
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
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13
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Abstract
The female genital tract microbiota is part of a complex ecosystem influenced by several physiological, genetic, and behavioral factors. It is uniquely linked to a woman's mucosal immunity and plays a critical role in the regulation of genital inflammation. A vaginal microbiota characterized by a high abundance of lactobacilli and low overall bacterial diversity is associated with lower inflammation. On the other hand, a more diverse microbiota is linked to high mucosal inflammation levels, a compromised genital epithelial barrier, and an increased risk of sexually transmitted infections and other conditions. Several bacterial taxa such as Gardnerella spp., Prevotella spp., Sneathia spp., and Atopobium spp. are well known to have adverse effects; however, the definitive cause of this microbial dysbiosis is yet to be fully elucidated. The aim of this review is to discuss the multiple ways in which the microbiota influences the overall genital inflammatory milieu and to explore the causes and consequences of this inflammatory response. While there is abundant evidence linking a diverse genital microbiota to elevated inflammation, understanding the risk factors and mechanisms through which it affects genital health is essential. A robust appreciation of these factors is important for identifying effective prevention and treatment strategies.
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Affiliation(s)
- Smritee Dabee
- Seattle Children's Research Institute, Seattle, Washington, USA
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | | | - Heather B Jaspan
- Seattle Children's Research Institute, Seattle, Washington, USA
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- University of Washington, Seattle, Washington, USA
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14
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Seah YM, Chang AM, Dabee S, Davidge B, Erickson JR, Olanrewaju AO, Price RM. Pandemic-Related Instructor Talk: How New Instructors Supported Students at the Onset of the COVID-19 Pandemic. J Microbiol Biol Educ 2021; 22:jmbe-22-51. [PMID: 33884087 PMCID: PMC8046655 DOI: 10.1128/jmbe.v22i1.2401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/31/2021] [Indexed: 05/26/2023]
Abstract
At the same time that COVID-19 cases in the United States first began to increase, fellows in a mentored teaching apprenticeship for postdoctoral scientists began to teach undergraduate seminars. The fellows suddenly needed to support students emotionally and switch to online instruction. They were encouraged to acknowledge and address the pandemic during each class and decided to do so. In this case study, we examined the language fellows used in response to this encouragement, hypothesizing that they would engage in a variety of pandemic-related instructor talk, i.e., language that instructors use in the classroom that is not directly tied to educational content. We analyzed transcripts from 17 2-hour undergraduate biology seminar courses and found 167 instances of pandemic-related instructor talk. We used grounded theory to identify categories that emerged from these quotations: Positive coping mechanisms and self-care; Adjusting to online learning; Compassionate instruction; Personal impacts; COVID-19 and society; Dreaming; and Biology of COVID-19. Talk in these categories may help build relationships among instructors and students. The category about quickly Adjusting to online learning is unique, in that it is unlikely that there will be another time that will require simultaneous and rapid national movement to online instruction. In addition, four of the seven categories are direct consequences of COVID-19 specifically, and thus are unique to this time. Analyzing pandemic-related instructor talk has shed light on how new instructors navigated the trials of teaching in 2020.
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Affiliation(s)
- Yee Mey Seah
- University of Washington Bothell, Bothell, WA 98011
| | - Ana M. Chang
- University of Washington School of Dentistry, Seattle, WA 98195
| | - Smritee Dabee
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98101
| | - Brittney Davidge
- Center for Global Infectious Disease Research, Seattle Children’s Research Institute, Seattle, WA 98101
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15
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Alisoltani A, Manhanzva MT, Potgieter M, Balle C, Bell L, Ross E, Iranzadeh A, du Plessis M, Radzey N, McDonald Z, Calder B, Allali I, Mulder N, Dabee S, Barnabas S, Gamieldien H, Godzik A, Blackburn JM, Tabb DL, Bekker LG, Jaspan HB, Passmore JAS, Masson L. Microbial function and genital inflammation in young South African women at high risk of HIV infection. Microbiome 2020; 8:165. [PMID: 33220709 PMCID: PMC7679981 DOI: 10.1186/s40168-020-00932-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Female genital tract (FGT) inflammation is an important risk factor for HIV acquisition. The FGT microbiome is closely associated with inflammatory profile; however, the relative importance of microbial activities has not been established. Since proteins are key elements representing actual microbial functions, this study utilized metaproteomics to evaluate the relationship between FGT microbial function and inflammation in 113 young and adolescent South African women at high risk of HIV infection. Women were grouped as having low, medium, or high FGT inflammation by K-means clustering according to pro-inflammatory cytokine concentrations. RESULTS A total of 3186 microbial and human proteins were identified in lateral vaginal wall swabs using liquid chromatography-tandem mass spectrometry, while 94 microbial taxa were included in the taxonomic analysis. Both metaproteomics and 16S rRNA gene sequencing analyses showed increased non-optimal bacteria and decreased lactobacilli in women with FGT inflammatory profiles. However, differences in the predicted relative abundance of most bacteria were observed between 16S rRNA gene sequencing and metaproteomics analyses. Bacterial protein functional annotations (gene ontology) predicted inflammatory cytokine profiles more accurately than bacterial relative abundance determined by 16S rRNA gene sequence analysis, as well as functional predictions based on 16S rRNA gene sequence data (p < 0.0001). The majority of microbial biological processes were underrepresented in women with high inflammation compared to those with low inflammation, including a Lactobacillus-associated signature of reduced cell wall organization and peptidoglycan biosynthesis. This signature remained associated with high FGT inflammation in a subset of 74 women 9 weeks later, was upheld after adjusting for Lactobacillus relative abundance, and was associated with in vitro inflammatory cytokine responses to Lactobacillus isolates from the same women. Reduced cell wall organization and peptidoglycan biosynthesis were also associated with high FGT inflammation in an independent sample of ten women. CONCLUSIONS Both the presence of specific microbial taxa in the FGT and their properties and activities are critical determinants of FGT inflammation. Our findings support those of previous studies suggesting that peptidoglycan is directly immunosuppressive, and identify a possible avenue for biotherapeutic development to reduce inflammation in the FGT. To facilitate further investigations of microbial activities, we have developed the FGT-DB application that is available at http://fgtdb.org/ . Video Abstract.
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Affiliation(s)
- Arghavan Alisoltani
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA, 92521, USA
| | - Monalisa T Manhanzva
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Matthys Potgieter
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Christina Balle
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Liam Bell
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Elizabeth Ross
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Arash Iranzadeh
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | | | - Nina Radzey
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Zac McDonald
- Centre for Proteomic and Genomic Research, Cape Town, 7925, South Africa
| | - Bridget Calder
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Imane Allali
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Laboratory of Human Pathologies Biology, Department of Biology and Genomic Center of Human Pathologies, Mohammed V University, Rabat, Morocco
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for Infectious Diseases Research (CIDRI) in Africa Wellcome Trust Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Smritee Dabee
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Seattle Children's Research Institute, University of Washington, Seattle, WA, 98101, USA
| | - Shaun Barnabas
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Hoyam Gamieldien
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
| | - Adam Godzik
- Division of Biomedical Sciences, University of California Riverside School of Medicine, Riverside, CA, 92521, USA
| | - Jonathan M Blackburn
- Division of Chemical and Systems Biology, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
| | - David L Tabb
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Bioinformatics Unit, South African Tuberculosis Bioinformatics Initiative, Stellenbosch University, Stellenbosch, 7602, South Africa
- DST-NRF Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Stellenbosch, 7602, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7925, South Africa
| | - Heather B Jaspan
- Division of Immunology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Seattle Children's Research Institute, University of Washington, Seattle, WA, 98101, USA
| | - Jo-Ann S Passmore
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa
- National Health Laboratory Service, Cape Town, 7925, South Africa
| | - Lindi Masson
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, 7925, South Africa.
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, 7925, South Africa.
- Centre for the AIDS Programme of Research in South Africa, Durban, 4013, South Africa.
- Disease Elimination Program, Life Sciences Discipline, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia.
- Central Clinical School, Monash University, Melbourne, 3004, Australia.
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16
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Dabee S, Mkhize NN, Jaspan HB, Lewis D, Gumbi PP, Passmore JAS. Initiation of Antiretroviral Therapy Differentially Influences Genital and Systemic Immune Activation in HIV-Infected Women. AIDS Res Hum Retroviruses 2020; 36:821-830. [PMID: 32524856 DOI: 10.1089/aid.2019.0268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Antiretroviral therapy (ART) has significantly improved the quality of life of HIV-infected individuals: reducing plasma viremia, restoring CD4+ T cell numbers, and correcting imbalances in blood memory T cell subsets. While ART improves immune correlates at mucosal sites, including the lower female genital tract (FGT), ART initiation has been associated with reactivation of common FGT infections. We investigated the effect of ART on immune activation and inflammation in the genital tract. We measured blood and genital T cell activation, proliferation, and immunosenescence (CD38, HLADR, Ki67, CD127, and CD57), and cytokine levels in women on ART for ∼7 years (cross-sectional analysis) or initiating ART (immediately before and 1 month after). Effector memory T cells predominated in blood and FGT during chronic infection, irrespective of ART status. In women initiating ART, 1 month was insufficient for T cell reconstitution, or alterations in T cell subset distribution, despite both plasma and genital viral loads decreasing to undetectable levels in most participants. Initiating ART was accompanied by a decline in plasma IP-10 that correlated with decreased blood CD38 expression in blood (p = .0204) but not in the FGT. The reduction in plasma (but not genital) cytokine levels due to ART initiation was dependent on their concentrations before treatment. While T cell activation decreased significantly in blood (CD4: p = .032; CD8: p = .0137), activation levels remained similar in the genital tract despite 1 month of treatment. Overall, the decrease in cellular activation and inflammation seen in blood with ART initiation was not evident in the FGT.
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Affiliation(s)
- Smritee Dabee
- Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | | | - Heather B. Jaspan
- Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Seattle Childrens Hospital, Seattle, Washington, USA
| | - David Lewis
- Western Sydney Sexual Health Centre, Parramatta, Australia
- Westmead Clinical School and Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
| | - Pamela P. Gumbi
- Department of Biochemistry, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Jo-Ann S. Passmore
- Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- NRF-DST Centre of Excellence in HIV Prevention, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal, Durban, South Africa
- National Health Laboratory Service, Cape Town, South Africa
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17
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Happel AU, Kullin B, Gamieldien H, Wentzel N, Zauchenberger CZ, Jaspan HB, Dabee S, Barnabas SL, Jaumdally SZ, Dietrich J, Gray G, Bekker LG, Froissart R, Passmore JAS. Exploring potential of vaginal Lactobacillus isolates from South African women for enhancing treatment for bacterial vaginosis. PLoS Pathog 2020; 16:e1008559. [PMID: 32497109 PMCID: PMC7271994 DOI: 10.1371/journal.ppat.1008559] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 04/16/2020] [Indexed: 12/12/2022] Open
Abstract
Antibiotics continue to be the standard-of-care for bacterial vaginosis (BV), although recurrence rates are high. Vaginal probiotics may improve durability of BV treatment, although few probiotics for vaginal health contain Lactobacillus spp. that commonly colonize the lower female genital tract. Characteristics of vaginal Lactobacillus strains from South African women were evaluated for their probiotic potential in vitro compared to strains from commercial vaginal products, including growth at varying pHs, ability to lower pH, produce D-/L-lactate and H2O2, influence growth of BV-associated Gardnerella vaginalis and Prevotella bivia, adherence to cervical cells and susceptibility to antibiotics. Fifty-seven Lactobacillus strains were purified from cervico-vaginal fluid, including L. crispatus, L. jensenii, L. gasseri, L. mucosae, and L. vaginalis. L crispatus strains grew better at pHs below 4.5 and lowered pH more effectively than other strains. Production of D-/L-lactate and H2O2 varied between Lactobacillus species and strains. Lactobacillus strains generally inhibited P. bivia more uniformly than G. vaginalis isolates. All vaginal Lactobacillus isolates were resistant to metronidazole while susceptibility to clindamycin varied. Furthermore, vaginal Lactobacillus strains tended to be broadly susceptible to penicillin, amoxicillin, rifampicin and rifabutin. Whole-genome-sequencing of five of the best-performing vaginal Lactobacillus strains confirmed their likely safety, due to antimicrobial resistance elements being largely absent, while putative intact prophages were present in the genomes of two of the five strains. Overall, vaginal Lactobacillus strains largely performed better in these in vitro assays than probiotic strains currently used in probiotics for vaginal health. Including the best-performing vaginal Lactobacillus isolates in a region-specific probiotic for vaginal health may result in improved BV treatment options.
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Affiliation(s)
- Anna-Ursula Happel
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Brian Kullin
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Hoyam Gamieldien
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Nicole Wentzel
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Chambrez Z. Zauchenberger
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Heather B. Jaspan
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Seattle Children’s Hospital, Seattle, United States of America
| | - Smritee Dabee
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Seattle Children’s Hospital, Seattle, United States of America
| | - Shaun L. Barnabas
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Family Centre for Research with Ubuntu (FAMCRU), Stellenbosch University, Tygerberg, South Africa
| | - Shameem Z. Jaumdally
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Linda-Gail Bekker
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Remy Froissart
- UMR MIVEGEC CNRS-IRD-UM, University Montpellier, Montpellier, France
| | - Jo-Ann S. Passmore
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- NRF-DST CAPRISA Centre of Excellence in HIV Prevention, Cape Town, South Africa
- National Health Laboratory Service (NHLS), Cape Town, South Africa
- * E-mail:
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18
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Shacklett BL, Blanco J, Hightow-Weidman L, Mgodi N, Alcamí J, Buchbinder S, Chirenje M, Dabee S, Diallo M, Dumchev K, Herrera C, Levy ME, Martin Gayo E, Makoah NA, Mitchell KM, Mugwanya K, Reddy K, Rodríguez ML, Rodriguez-Garcia M, Shover CL, Shrivastava T, Tomaras G, Van Diepen M, Walia M, Warren M, Manrique A, Thyagarajan B, Torri T. HIV Research for Prevention 2018: From Research to Impact Conference Summary and Highlights. AIDS Res Hum Retroviruses 2019; 35:598-607. [PMID: 31007035 PMCID: PMC6602109 DOI: 10.1089/aid.2019.0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The HIV Research for Prevention (HIVR4P) conference is dedicated to advancing HIV prevention research, responding to a growing consensus that effective and durable prevention will require a combination of approaches as well as unprecedented collaboration among scientists, practitioners, and community workers from different fields and geographic areas. The conference theme in 2018, "From Research to Impact," acknowledged an increasing focus on translation of promising research findings into practical, accessible, and affordable HIV prevention options for those who need them worldwide. HIVR4P 2018 was held in Madrid, Spain, on 21-25 October, with >1,400 participants from 52 countries around the globe, representing all aspects of HIV prevention research and implementation. The program included 137 oral and 610 poster presentations. This article presents a brief summary of highlights from the conference. More detailed information, complete abstracts as well as webcasts and daily Rapporteur summaries may be found on the conference website.
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Affiliation(s)
- Barbara L. Shacklett
- Medical Microbiology and Immunology, University of California, Davis, Davis, California
| | - Julià Blanco
- IrsiCaixa, IGTP, Barcelona, Spain
- Chair in AIDS and Related Illnesses, Centre for Health and Social Care Research (CESS), Faculty of Medicine, University of Vic-UCC, Barcelona, Spain
| | - Lisa Hightow-Weidman
- Division of Infectious Diseases, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Nyaradzo Mgodi
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - José Alcamí
- AIDS Immunopathology Unit, Instituto de Salud Carlos III, Madrid, Spain
| | - Susan Buchbinder
- San Francisco Department of Public Health, San Francisco, California
| | - Mike Chirenje
- University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Smritee Dabee
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Mamadou Diallo
- Department of Social and Preventive Medicine, University Laval, Quebec, Canada
| | | | - Carolina Herrera
- Faculty of Medicine, Department of Medicine, Imperial College London, London, United Kingdom
| | - Matthew E. Levy
- Department of Epidemiology and Biostatistics, The George Washington University, Washington, District of Columbia
| | - Enrique Martin Gayo
- Immunology Department, Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
| | - Nigel Aminake Makoah
- Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Kate M. Mitchell
- MRC Centre for Global Infectious Disease Analysis, Imperial College London, London, United Kingdom
- HPTN Modelling Centre, Imperial College London, London, United Kingdom
| | - Kenneth Mugwanya
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Clinical Medicine, Johannesburg, South Africa
| | | | - Marta Rodriguez-Garcia
- Department of Physiology and Neurobiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Chelsea L. Shover
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California
| | - Tripti Shrivastava
- Department of Infection and Immunology, Translational Health Science and Technology Institute, Faridabad, India
| | - Georgia Tomaras
- Departments of Surgery, Immunology, and Molecular Genetics and Microbiology, Duke University, Durham, North Carolina
| | - Michiel Van Diepen
- Division of Medical Virology, University of Cape Town, Cape Town, South Africa
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19
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Nono JK, Kamdem SD, Netongo PM, Dabee S, Schomaker M, Oumarou A, Brombacher F, Moyou-Somo R. Schistosomiasis Burden and Its Association With Lower Measles Vaccine Responses in School Children From Rural Cameroon. Front Immunol 2018; 9:2295. [PMID: 30356757 PMCID: PMC6189399 DOI: 10.3389/fimmu.2018.02295] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/17/2018] [Indexed: 12/19/2022] Open
Abstract
Background and Methods: Schistosomiasis is debilitating and reported to impair immune responsiveness of infected hosts. In Cameroon, mass drug administration (MDA) is used in schoolchildren to reduce transmission of S. haematobium and S. mansoni. The effects of MDA and the impact of schistosomiasis on the titers of antibodies in vaccinated children have been poorly studied. We therefore assessed the prevalence of schistosomiasis in schoolchildren, eight months after MDA, in two locations: Barombi Koto (BK), endemic for S. haematobium (N = 169) and Yoro (Y), endemic for S. mansoni (N = 356). Age, gender, residence time and frequency of contact with river water were assessed as risk factors for infection and morbidity in both localities. In 70 schoolchildren from BK and 83 from Y, ultrasound was used to assess morbidity according to the WHO guidelines. Evaluation of measles antibodies was performed in previously vaccinated schoolchildren (14 with S. haematobium and 12 egg-negative controls from BK and 47 with S. mansoni and12 egg-negative controls from Y). Principal Findings and conclusions: The prevalence of S. haematobium was 25. 4% in BK (43/169) and 34.8% for S. mansoni in Y (124/356), indicating the persistent transmission of schistosomiasis despite MDA. Older age (AOR 1.31; 95%CI 1.12–1.54) and higher frequencies of exposure to river water (AOR 1.99; 95%CI 1.03–3.86) were identified as risks for infection in BK whereas only older age (OR 1.15; 95%CI 1.04–1.27) was a risk for infection in Y. Bladder pathology (score 2 to 5) was observed in 29.2% (7/24) of egg-positive children in BK and liver pathology (pattern C) in 31.1% (19/61) of egg-positive children in Y. There was a positive correlation between S. haematobium egg burden and bladder pathology (AOR 1.01; 95% CI 0.99–1.02) and positive correlation between S. mansoni-driven liver pathology and female gender (AOR 3.01; 95% CI 0.88–10.26). Anti-measles antibodies in vaccinated children were significantly lower in S. mansoni-infected when compared to egg-negative controls (p = 0.001), which was not observed in the S. haematobium-infected group from BK. Our results demonstrate a questionable efficacy of MDA alone in halting schistosomiasis transmission and confirm a possible immunomodulatory effect of S. mansoni on response to vaccines.
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Affiliation(s)
- Justin Komguep Nono
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon.,Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.,Cytokines and Diseases Group, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Immunology of Infectious Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Severin Donald Kamdem
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.,Cytokines and Diseases Group, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Immunology of Infectious Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | | | - Smritee Dabee
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa
| | | | - Frank Brombacher
- Division of Immunology, Health Science Faculty, University of Cape Town, Cape Town, South Africa.,Cytokines and Diseases Group, International Centre for Genetic Engineering and Biotechnology, Cape Town, South Africa.,Immunology of Infectious Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Roger Moyou-Somo
- The Medical Research Centre, Institute of Medical Research and Medicinal Plant Studies, Ministry of Scientific Research and Innovation, Yaoundé, Cameroon
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20
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Masson L, Barnabas S, Deese J, Lennard K, Dabee S, Gamieldien H, Jaumdally SZ, Williamson AL, Little F, Van Damme L, Ahmed K, Crucitti T, Abdellati S, Bekker LG, Gray G, Dietrich J, Jaspan H, Passmore JAS. Inflammatory cytokine biomarkers of asymptomatic sexually transmitted infections and vaginal dysbiosis: a multicentre validation study. Sex Transm Infect 2018; 95:5-12. [PMID: 30018088 DOI: 10.1136/sextrans-2017-053506] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/11/2018] [Accepted: 06/15/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Vaginal dysbiosis and STIs are important drivers of the HIV epidemic and reproductive complications. These conditions remain prevalent, partly because most cases are asymptomatic. We have shown that inflammatory cytokines interleukin (IL)-1α, IL-1β and interferon-γ-induced protein (IP)-10 are biomarkers for detecting asymptomatic STIs and vaginal dysbiosis (bacterial vaginosis (BV) or intermediate microbiota). This study aimed to validate the performance of these biomarkers in African women recruited regardless of symptoms. METHODS IL-1α, IL-1β and IP-10 were measured in menstrual cup secretions, endocervical, lateral vaginal wall and vulvovaginal swabs from 550 women from Pretoria, Soweto and Cape Town, South Africa and Bondo, Kenya using Luminex and ELISA. STIs were assessed by PCR, BV by Nugent scoring and vaginal microbiota by 16S rRNA sequencing. RESULTS Across four study populations and four types of genital specimens, the performance of IL-1α, IL-1β and IP-10 for identification of women with STIs, BV or intermediate microbiota was consistent. Of the genital samples assessed, biomarkers measured in lateral vaginal wall swabs performed best, correctly classifying 76%(95% CI 70% to 81%) of women according to STI, BV or intermediate microbiota status (sensitivity 77%, specificity 71%) and were more accurate than clinical symptoms (sensitivity 41%, specificity 57%) (p=0.0003). Women incorrectly classified as STI/BV positive using the biomarkers had more abundant dysbiosis-associated bacteria, including Prevotella bivia and Gardnerella sp, detected by 16S rRNA sequencing, but not Nugent scoring. Including vaginal pH with the cytokine biomarkers improved the accuracy of the test (82% (95% CI 75% to 88%) correctly classified), although pH alone had poor specificity (61%). CONCLUSIONS An inexpensive, point-of-care screening test including IL-1α, IL-1β and IP-10 (and potentially pH) could be used in resource-limited settings to identify women with asymptomatic STIs and dysbiosis. These women could then be referred for aetiological testing, followed by specific treatment.
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Affiliation(s)
- Lindi Masson
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Shaun Barnabas
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Jennifer Deese
- Contraceptive Technology and Innovation Department, Family Health International 360, Durham, North Carolina, USA.,Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katie Lennard
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Hoyam Gamieldien
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
| | - Francesca Little
- Department of Statistical Sciences, University of Cape Town, Cape Town, South Africa
| | - Lut Van Damme
- The Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | - Tania Crucitti
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Saïd Abdellati
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.,South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Heather Jaspan
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,Seattle Children's Research Institute, University of Washington, Seattle, Washington, USA
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,National Health Laboratory Service, Johannesburg, South Africa
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21
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Mbulawa ZZA, van Schalkwyk C, Hu NC, Meiring TL, Barnabas S, Dabee S, Jaspan H, Kriek JM, Jaumdally SZ, Muller E, Bekker LG, Lewis DA, Dietrich J, Gray G, Passmore JAS, Williamson AL. High human papillomavirus (HPV) prevalence in South African adolescents and young women encourages expanded HPV vaccination campaigns. PLoS One 2018; 13:e0190166. [PMID: 29293566 PMCID: PMC5749739 DOI: 10.1371/journal.pone.0190166] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 12/08/2017] [Indexed: 11/18/2022] Open
Abstract
The objectives of the study were to investigate prevalence of cervical human papillomavirus (HPV) genotypes to inform HPV vaccination strategy in South Africa and to study factors associated with HPV prevalence. Sexually active, HIV-negative women, aged 16-22 years recruited from Soweto (n = 143) and Cape Town (n = 148) were tested for cervical HPV and other genital infections. Overall HPV prevalence was 66.7% (194/291) in young women. Cape Town women were more likely to have multiple HPV infections than the Soweto women (48.0%, 71/148 versus 35.0%, 50/143 respectively, p = 0.033) and probable HR-HPV types (34.5%, 51/148 versus 21.7%, 31/143 respectively, p = 0.022). The most frequently detected HPV types were HPV-16 (11.7%), HPV-58 (10.3%), HPV-51 (8.9%), HPV-66 (8.6%), HPV-18 and HPV-81 (7.6% each). HPV types targeted by the bivalent HPV vaccine (HPV-16/18) were detected in 18.6% (54/291) of women, while those in the quadrivalent vaccine (HPV-6/11/16/18) were detected in 24.7% (72/291) of women; and those in the nonavalent vaccine (HPV-6/11/16/18/31/33/45/52/58) were detected in 38.5% (112/291) of women. In a multivariable analysis, bacterial vaginosis remained significantly associated with HPV infection (OR: 4.0, 95% CI: 1.4-12.6). Women were more likely to be HPV positive if they had received treatment for STI during the past 6-months (OR: 3.4, 95% CI: 1.1-12.4) or if they had ever been pregnant (OR: 2.3, 95% CI: 1.1-5.5). Compared to women who reported only one sexual partner, those with increased number of lifetime sex partners were more likely to have HPV (4-10 partners: OR: 2.9, 95% CI: 1.1-8.0). The high prevalence of HPV types targeted by the nonavalent HPV vaccine encourages the introduction of this vaccine and catch-up HPV vaccination campaigns in South Africa. The high burden of BV and concurrent STIs also highlights the need to improve the prevention and appropriate management of sexually-acquired and other genital tract infections in South African youth.
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Affiliation(s)
- Zizipho Z. A. Mbulawa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Johannesburg, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- UCT-MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Cari van Schalkwyk
- The South African Department of Science and Technology/National Research Foundation Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
| | - Nai-Chung Hu
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Tracy L. Meiring
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Shaun Barnabas
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Heather Jaspan
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Seattle Children’s Research Institute, University of Washington, Seattle, United States
| | - Jean-Mari Kriek
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Shameem Z. Jaumdally
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
| | - Etienne Muller
- Center for HIV and STIs, National Institute for Communicable Disease, National Health Laboratory Service, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - David A. Lewis
- Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity & Sydney Medical School-Westmead, University of Sydney, Sydney, Australia
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, Johannesburg, South Africa
- Canada-African Prevention Trials Network, The Ottawa Hospital General Campus, Ottawa, Canada
| | - Glenda Gray
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Diepkloof, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, Division of Medical Virology, University of Cape Town, Cape Town, South Africa
- UCT-MRC Clinical Gynaecological Cancer Research Centre, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Observatory, Cape Town, South Africa
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22
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Lennard K, Dabee S, Barnabas SL, Havyarimana E, Blakney A, Jaumdally SZ, Botha G, Mkhize NN, Bekker LG, Lewis DA, Gray G, Mulder N, Passmore JAS, Jaspan HB. Microbial Composition Predicts Genital Tract Inflammation and Persistent Bacterial Vaginosis in South African Adolescent Females. Infect Immun 2018; 86:e00410-17. [PMID: 29038128 PMCID: PMC5736802 DOI: 10.1128/iai.00410-17] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022] Open
Abstract
Young African females are at an increased risk of HIV acquisition, and genital inflammation or the vaginal microbiome may contribute to this risk. We studied these factors in 168 HIV-negative South African adolescent females aged 16 to 22 years. Unsupervised clustering of 16S rRNA gene sequences revealed three clusters (subtypes), one of which was strongly associated with genital inflammation. In a multivariate model, the microbiome compositional subtype and hormonal contraception were significantly associated with genital inflammation. We identified 40 taxa significantly associated with inflammation, including those reported previously (Prevotella, Sneathia, Aerococcus, Fusobacterium, and Gemella) as well as several novel taxa (including increased frequencies of bacterial vaginosis-associated bacterium 1 [BVAB1], BVAB2, BVAB3, Prevotella amnii, Prevotella pallens, Parvimonas micra, Megasphaera, Gardnerella vaginalis, and Atopobium vaginae and decreased frequencies of Lactobacillus reuteri, Lactobacillus crispatus, Lactobacillus jensenii, and Lactobacillus iners). Women with inflammation-associated microbiomes had significantly higher body mass indices and lower levels of endogenous estradiol and luteinizing hormone. Community functional profiling revealed three distinct vaginal microbiome subtypes, one of which was characterized by extreme genital inflammation and persistent bacterial vaginosis (BV); this subtype could be predicted with high specificity and sensitivity based on the Nugent score (≥9) or BVAB1 abundance. We propose that women with this BVAB1-dominated subtype may have chronic genital inflammation due to persistent BV, which may place them at a particularly high risk for HIV infection.
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Affiliation(s)
- Katie Lennard
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Shaun L Barnabas
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Enock Havyarimana
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Anna Blakney
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Shameem Z Jaumdally
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Gerrit Botha
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Nonhlanhla N Mkhize
- National Institute for Communicable Diseases, Sandringham, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, Australia
- Sydney Medical School-Westmead, University of Sydney, Sydney, Australia
- National Institute for Communicable Diseases, Sandringham, Johannesburg, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- South African Medical Research Council, Cape Town, South Africa
| | - Nicola Mulder
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S Passmore
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | - Heather B Jaspan
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Department of Pathology, University of Cape Town, Cape Town, South Africa
- Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
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23
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Barnabas SL, Dabee S, Passmore JAS, Jaspan HB, Lewis DA, Jaumdally SZ, Gamieldien H, Masson L, Muller E, Maseko VD, Mkhize N, Mbulawa Z, Williamson AL, Gray CM, Hope TJ, Chiodi F, Dietrich J, Gray G, Bekker LG. Converging epidemics of sexually transmitted infections and bacterial vaginosis in southern African female adolescents at risk of HIV. Int J STD AIDS 2017; 29:531-539. [PMID: 29198180 DOI: 10.1177/0956462417740487] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adolescents in Africa are at high risk for HIV infection, other sexually transmitted infections (STIs) and bacterial vaginosis (BV). Since behavior and burden of STIs/BV may influence HIV risk, behavioral risk factors and prevalence of STIs/BV were compared in HIV-seronegative adolescent females (n = 298; 16-22 years) from two South African communities (Soweto and Cape Town). STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, herpes simplex virus (HSV)-1, HSV-2, Treponema pallidum, and Haemophilus ducreyi) were detected by multiplex polymerase chain reaction, human papillomavirus (HPV) by Roche Linear Array, and BV by Nugent scoring. Rates of BV (Nugent ≥7; 46.6%) and HPV (66.8%) were high in both communities. Prevalence of C. trachomatis and N. gonorrhoeae were >2-fold higher in Cape Town than Soweto (Chlamydia: 42% [62/149] versus 18% [26/148], p < 0.0001; gonorrhoea 11% [17/149] versus 5% [7/148], p = 0.05). Only 24% of adolescents with vaginal discharge-causing STIs or BV were symptomatic. In South African adolescents, clinical symptoms compatible with vaginal discharge syndrome had a sensitivity of 23% and specificity of 85% for the diagnosis of discharge-causing STI or BV. In a region with high HIV prevalence and incidence, >70% of young women with treatable conditions that could enhance HIV risk would have been missed because they lacked symptoms associated with syndromic management.
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Affiliation(s)
- Shaun L Barnabas
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,2 Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Smritee Dabee
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S Passmore
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.,4 DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa
| | - Heather B Jaspan
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,5 145793 Seattle Children's Research Institute , University of Washington, Seattle, WA, USA
| | - David A Lewis
- 6 Western Sydney Sexual Health Centre, Western Sydney Local Health District, Parramatta, Australia.,7 Centre for Infectious Diseases and Microbiology & Marie Bashir Institute for Infectious Diseases and Biosecurity, Westmead Clinical School, University of Sydney, Sydney, Australia.,8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa
| | - Shameem Z Jaumdally
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,4 DST-NRF CAPRISA Centre of Excellence in HIV Prevention, University of Cape Town, Cape Town, South Africa
| | - Hoyam Gamieldien
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Lindi Masson
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Etienne Muller
- 8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa
| | - Venessa D Maseko
- 8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa
| | - Nonhlanhla Mkhize
- 8 Centre for HIV and STIs, 70687 National Institute for Communicable Disease , National Health Laboratory Service, Johannesburg, South Africa
| | - Zizipho Mbulawa
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Anna-Lise Williamson
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa.,9 SAMRC/UCT Gynaecological Cancer Research Centre Center for HIV and STIs, Cape Town, South Africa
| | - Clive M Gray
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,3 National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Janan Dietrich
- 12 Perinatal HIV Research Unit, Faculty of Health Sciences, 196579 University of the Witwatersrand , Diepkloof, Johannesburg, South Africa
| | - Glenda Gray
- 12 Perinatal HIV Research Unit, Faculty of Health Sciences, 196579 University of the Witwatersrand , Diepkloof, Johannesburg, South Africa.,13 59097 South African Medical Research Council , Cape Town, South Africa
| | - Linda-Gail Bekker
- 1 Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,2 Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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24
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Dabee S, Barnabas SL, Jaspan HB, Jaumdally SZ, Gamieldien H, Masson L, Lewis D, Wallace M, Bennie T, Gray C, Williamson AL, Hope T, Chiodi F, Shattock R, Bekker LG, Passmore JS. P15.04 Genital tract cellular activation and inflammation associated with highly prevalent sexually transmitted infections and bacterial vaginosis in adolescent women at risk for hiv infection. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052270.545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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25
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Barnabas S, Dabee S, Jaspan HB, Jaumdally SZ, Gamieldien H, Masson L, Lewis D, Wallace M, Bennie T, Gray C, Williamson AL, Hope T, Chiodi F, Shattock R, Bekker LG, Gray G, Dietrich J, Passmore JS. O18.3 Adolescents in south africa and assessment of hiv risk: knowing who we are trying to protect. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Barnabas SL, Jaspan HB, Dabee S, Jaumdally SZ, Gamieldien H, Lewis D, Williamson AL, Bennie T, Phuti A, van der Watt M, Dietrich J, Mulder N, Gray C, Hope TJ, Chiodi F, Shattock R, Morris L, Mkhize NN, Gray G, Bekker LG, Passmore JAS. Knowing Whom We Are trying to Protect: An Assessment of HIV Risk in South African Adolescent Females. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5260.abstract] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shaun L. Barnabas
- University of Cape Town, Medical Virology, Cape Town, South Africa
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - Heather B. Jaspan
- University of Cape Town, Department of Immunology, Cape Town, South Africa
- Seattle Biomedical Research Institute, Seattle, WA, United States
| | - Smritee Dabee
- University of Cape Town, Medical Virology, Cape Town, South Africa
| | | | - Hoyam Gamieldien
- University of Cape Town, Medical Virology, Cape Town, South Africa
| | - David Lewis
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Anna-Lise Williamson
- University of Cape Town, Medical Virology, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Thola Bennie
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - Angel Phuti
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | | | - Janan Dietrich
- Perinatal and HIV Research Unit, Johannesburg, South Africa
| | - Nicola Mulder
- University of Cape Town, Computational Biology, Cape Town, South Africa
| | - Clive Gray
- University of Cape Town, Immunology, Cape Town, South Africa
| | - Thomas J. Hope
- Northwestern University, Department of Cell and Molecular Biology, Feinberg School of Medicine, Chicago, IL, United States
| | - Francesca Chiodi
- Karolinska Institutet, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Robin Shattock
- Imperial College, Department of Infectious Diseases, Division of Medicine, London, United Kingdom
| | - Lynn Morris
- National Institute for Communicable Diseases, Johannesburg, South Africa
- National Health Laboratory Service, Johannesburg, South Africa
| | | | - Glenda Gray
- Perinatal and HIV Research Unit, Johannesburg, South Africa
- HIV Vaccine Trials Network, Johannesburg, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Cape Town, South Africa
- Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- University of Cape Town, Medical Virology, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
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27
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Dabee S, Kriek JM, Lewis D, Venessa M, Nonhlanhla M, Gumbi PP, Mbulawa Z, Williamson AL, Jaspan HB, Passmore JAS. Genital IRIS, Immune Activation and Inflammation in the Female Genital Tract Influences HIV Shedding in HIV-infected Women Starting HAART. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5505.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
| | - Jean-Mari Kriek
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
| | - David Lewis
- National Institute for Communicable Diseases, Johannesburg, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Maseko Venessa
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Mkhize Nonhlanhla
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Pamela P. Gumbi
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Zizipho Mbulawa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
| | - Heather B. Jaspan
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
| | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
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28
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Dabee S, Jaspan HB, Barnabas SL, Jaumdally SZ, Gamieldien H, Lewis D, Bennie T, Phuti A, Gray CM, Williamson AL, Hope TJ, Chiodi F, Shattock R, Passmore JAS, Bekker LG. Immune Activation and HIV Target Cells in the Adolescent Female Genital Tract. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5078.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Smritee Dabee
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
| | - Heather B. Jaspan
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- Seattle Biomed, Seattle, WA, United States
| | - Shaun L. Barnabas
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - Shameem Z. Jaumdally
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
| | - Hoyam Gamieldien
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
| | - David Lewis
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Microbiology, Cape Town, South Africa
- National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Thola Bennie
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - Angel Phuti
- Desmond Tutu HIV Foundation, Cape Town, South Africa
| | - Clive M. Gray
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
| | - Anna-Lise Williamson
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
| | - Thomas J. Hope
- Feinberg School of Medicine, Northwestern University, Department of Cell and Molecular Biology, Chicago, IL, United States
| | - Francesca Chiodi
- Karolinska Institutet, Department of Microbiology, Tumor and Cell Biology, Stockholm, Sweden
| | - Robin Shattock
- Imperial College London, Department of Infectious Diseases, London, United Kingdom
| | - Jo-Ann S. Passmore
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Department of Clinical Laboratory Sciences, Cape Town, South Africa
- National Health Laboratory Services, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Foundation, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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29
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Dabee S, Passmore J, Williamson A, Gumbi P. Impact of the innate environment on maintaining memory T-cell numbers in the female genital tract: implications for mucosal vaccine efficacy? Retrovirology 2012. [PMCID: PMC3441263 DOI: 10.1186/1742-4690-9-s2-p193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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