Centre for the AIDS Programme of Research in South Africa, South Africa; University of KwaZulu-Natal, School of Laboratory Medicine and Medical Science, Department of Medical Microbiology, South Africa.
Centre for the AIDS Programme of Research in South Africa, South Africa.
J Reprod Immunol. 2021 Jun;145:103291. doi: 10.1016/j.jri.2021.103291. Epub 2021 Feb 17.
Given that heterosexual transmission of HIV across the genital mucosa is the most common route of infection in women, an in-depth understanding of the biological mechanisms associated with HIV risk in the female genital tract (FGT) is essential for effective control of the epidemic. Genital pro-inflammatory cytokines are well-described biological co-factors to HIV risk. Increased levels of pro-inflammatory cytokines in the FGT have been associated with a 3-fold higher-risk of acquiring HIV, presumably through involvement in barrier compromise and the recruitment of highly activated HIV target cells to the site of initial viral infection and replication. Sexually transmitted infections (STIs) and bacterial vaginosis (BV) are suggested possible contributors to genital inflammation in the FGT, and this, coupled with the relationship between genital inflammation and HIV risk, underscores the importance of effective treatment of STI and BV in the promotion of women's health. In most low- and middle-income countries, STIs are treated syndromically, a practice providing rapid treatment without identifying the infection source. However, this approach has been associated with over-diagnosis and the overuse of drugs. Further, because many women with STIs are asymptomatic, syndromic management also fails to treat a vast proportion of infected women. Although several studies have explored the role of STIs and the vaginal microbiome on genital inflammation and HIV risk, the impact of STI and BV management on genital inflammation remains poorly understood. This review aimed to collate the evidence on how BV and STI management efforts affect genital inflammation and the genital microbiome in women.
鉴于异性间通过生殖道黏膜传播 HIV 是女性最常见的感染途径，深入了解与女性生殖道（FGT）中 HIV 风险相关的生物学机制对于有效控制疫情至关重要。生殖道促炎细胞因子是众所周知的 HIV 风险的生物学协同因素。生殖道中促炎细胞因子水平升高与 HIV 感染风险增加 3 倍相关，这可能是通过参与屏障破坏以及招募高度激活的 HIV 靶细胞到初始病毒感染和复制部位。性传播感染（STI）和细菌性阴道病（BV）被认为可能导致 FGT 中的生殖道炎症，再加上生殖道炎症与 HIV 风险之间的关系，突显了有效治疗 STI 和 BV 对于促进女性健康的重要性。在大多数低收入和中等收入国家，STI 是根据综合征进行治疗的，这种做法在不明确感染源的情况下提供了快速治疗。然而，这种方法与过度诊断和过度用药有关。此外，由于许多患有 STI 的女性无症状，因此综合征管理也未能治疗很大一部分感染的女性。尽管有几项研究探讨了 STI 和阴道微生物群对生殖道炎症和 HIV 风险的作用，但 STI 和 BV 管理对生殖道炎症的影响仍知之甚少。本综述旨在整理有关 BV 和 STI 管理措施如何影响女性生殖道炎症和生殖道微生物群的证据。
