Department of Immunology, Tufts University School of Medicine, 150 Harrison Ave, Boston, MA, 02111, USA.
Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
Curr HIV/AIDS Rep. 2021 Apr;18(2):139-156. doi: 10.1007/s11904-021-00546-1. Epub 2021 Mar 15.
Women remain disproportionately affected by the HIV/AIDS pandemic. The primary mechanism for HIV acquisition in women is sexual transmission, yet the immunobiological factors that contribute to HIV susceptibility remain poorly characterized. Here, we review current knowledge on HIV pathogenesis in women, focusing on infection and immune responses in the female reproductive tract (FRT).
We describe recent findings on innate immune protection and HIV target cell distribution in the FRT. We also review multiple factors that modify susceptibility to infection, including sex hormones, microbiome, trauma, and how HIV risk changes during women's life cycle. Finally, we review current strategies for HIV prevention and identify barriers for research in HIV infection and pathogenesis in women. A complex network of interrelated biological and sociocultural factors contributes to HIV risk in women and impairs prevention and cure strategies. Understanding how HIV establishes infection in the FRT can provide clues to develop novel interventions to prevent HIV acquisition in women.
女性仍然受到艾滋病大流行的不成比例的影响。女性感染 HIV 的主要机制是性传播，但导致 HIV 易感性的免疫生物学因素仍未得到很好的描述。在这里，我们综述了女性 HIV 发病机制的最新知识，重点关注女性生殖道（FRT）中的感染和免疫反应。
我们描述了 FRT 中先天免疫保护和 HIV 靶细胞分布的最新发现。我们还回顾了多种改变感染易感性的因素，包括性激素、微生物组、创伤，以及 HIV 风险在女性生命周期中的变化。最后，我们综述了 HIV 预防的当前策略，并确定了 HIV 感染和发病机制研究的障碍。复杂的相互关联的生物和社会文化因素网络导致了女性的 HIV 风险，并损害了预防和治疗策略。了解 HIV 如何在 FRT 中建立感染可以为开发预防女性 HIV 感染的新干预措施提供线索。
