From the Department of Epidemiology, University of Washington.
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA.
Sex Transm Dis. 2021 Jul 1;48(7):499-507. doi: 10.1097/OLQ.0000000000001343.
Bacterial vaginosis (BV) is associated with an increased risk of high-risk human papillomavirus (hrHPV), whereas Lactobacillus-dominated vaginal microbiotas are associated with reduced burden of hrHPV. Few epidemiologic studies have prospectively investigated the relationships between vaginal bacteria and hrHPV, particularly among women from countries in Africa.
We conducted a prospective cohort study nested within the Preventing Vaginal Infections trial to evaluate associations between vaginal bacteria and hrHPV incidence and persistence. Sexually active, HIV-seronegative women aged 18 to 45 years who had a vaginal infection at screening were eligible to enroll. Analyses were restricted to participants enrolled in Kenya and randomized to placebo. At enrollment and months 2, 4, 6, 8, 10, and 12, hrHPV testing, quantitative polymerase chain reaction (measuring taxon quantity per swab), and 16S rRNA gene amplicon sequencing of the vaginal microbiota were performed. Generalized estimating equations multinomial logistic regression models were fit to evaluate associations between vaginal bacteria and incident and persistent hrHPV.
Eighty-four participants were included in this analysis. Higher concentrations of Lactobacillus crispatus were inversely associated with persistent hrHPV detection. Specifically, 1 tertile higher L. crispatus concentration was associated with 50% reduced odds of persistent hrHPV detection (odds ratio, 0.50; 95% confidence interval, 0.29-0.85).
This study is consistent with reports that vaginal L. crispatus is associated with reduced susceptibility to hrHPV persistence. Evidence from in vitro studies provides insight into potential mechanisms by which L. crispatus may mediate hrHPV risk. Future studies should further explore in vivo mechanisms that may drive this relationship and opportunities for intervention.
细菌性阴道病（BV）与高危型人乳头瘤病毒（hrHPV）的风险增加有关，而乳杆菌主导的阴道微生物群与 hrHPV 负担的减少有关。很少有流行病学研究前瞻性地调查阴道细菌与 hrHPV 之间的关系，特别是在来自非洲国家的女性中。
我们在预防阴道感染试验中进行了一项嵌套的前瞻性队列研究，以评估阴道细菌与 hrHPV 发生率和持续性之间的关系。符合条件的参与者为在筛查时患有阴道感染的 18 至 45 岁的性活跃、HIV 血清阴性的女性。分析仅限于在肯尼亚招募并随机分配至安慰剂的参与者。在入组时以及第 2、4、6、8、10 和 12 个月时，进行 hrHPV 检测、定量聚合酶链反应（测量每个拭子的分类数量）和阴道微生物群的 16S rRNA 基因扩增子测序。使用广义估计方程多变量逻辑回归模型评估阴道细菌与新发和持续性 hrHPV 之间的关系。
共有 84 名参与者纳入本分析。较高的乳酸杆菌 crispatus 浓度与持续性 hrHPV 检测呈负相关。具体而言，第 1 tertile 更高的 L. crispatus 浓度与持续性 hrHPV 检测的可能性降低 50%相关（比值比，0.50；95%置信区间，0.29-0.85）。
这项研究与阴道 L. crispatus 与降低对 hrHPV 持续性易感性相关的报告一致。来自体外研究的证据提供了对 L. crispatus 可能调节 hrHPV 风险的潜在机制的深入了解。未来的研究应进一步探讨可能驱动这种关系的体内机制和干预机会。
