Saidi Friday, Graybill Lauren A, Tang Jennifer H, Phanga Twambilile, Milala Beteniko, Banda Gabriel, Kamija Manley, Kasaro Margaret, Mutale Wilbroad, Price Joan, Chinula Lameck, Stringer Jeffrey, Hosseinipour Mina C, Chi Benjamin H, Ravel Jacques, Holm Johanna B
UNC Project Malawi, Lilongwe, Malawi.
Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
NPJ Biofilms Microbiomes. 2025 Apr 26;11(1):67. doi: 10.1038/s41522-025-00697-8.
Lack of Lactobacillus and/or dysbiosis is linked to spontaneous preterm birth (sPTB). The impact of antiretrovirals (ARVs) for HIV treatment or prevention on the vaginal microbiome during pregnancy remains unclear. We examined vaginal microbiome changes in pregnant women in Lilongwe, Malawi. Women living with HIV (WLHIV) initiated antiretroviral therapy (ART), while HIV-negative women began oral pre-exposure prophylaxis (PrEP). Of 255 participants (191 HIV-negative, 64 WLHIV) who provided baseline vaginal swabs, 181 provided follow-up swabs one month after ARV initiation. At enrollment, WLHIV had higher Shannon diversity and were more likely to have CST IV-B than CST I or III. After ARV initiation, α-diversity decreased in WLHIV but increased in HIV-negative women. Women initiating PrEP had a lower risk of sPTB compared to WLHIV initiating ART, but transitioning to CST IV during pregnancy increased the odds of sPTB. Larger studies are needed to explore ARV impact on pregnancy outcomes.
缺乏乳酸杆菌和/或微生物失调与自发性早产（sPTB）有关。抗逆转录病毒药物（ARV）用于治疗或预防HIV对孕期阴道微生物群的影响仍不清楚。我们研究了马拉维利隆圭孕妇的阴道微生物群变化。感染HIV的女性（WLHIV）开始接受抗逆转录病毒治疗（ART），而HIV阴性女性开始口服暴露前预防（PrEP）。在提供基线阴道拭子的255名参与者（191名HIV阴性，64名WLHIV）中，181名在开始使用ARV一个月后提供了随访拭子。在入组时，WLHIV的香农多样性更高，与CST I或III相比，更有可能具有CST IV - B。开始使用ARV后，WLHIV的α多样性降低，但HIV阴性女性的α多样性增加。与开始接受ART的WLHIV相比，开始使用PrEP的女性发生sPTB的风险更低，但孕期转变为CST IV会增加sPTB的几率。需要更大规模的研究来探讨ARV对妊娠结局的影响。
