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MINI REVIEW article

Front. Reprod. Health
Sec. HIV and STIs
Volume 6 - 2024 | doi: 10.3389/frph.2024.1431306

Ecology Meets Reproductive Medicine in HIV Prevention: The Case for Geography-Informed Approaches for Bacterial Vaginosis in Africa

Provisionally accepted
Jo-Ann S Passmore Jo-Ann S Passmore 1,2,3*Sinaye Ngcapu Sinaye Ngcapu 3Serah Gitome Serah Gitome 4Brian R Kullin Brian R Kullin 1Kirsten Welp Kirsten Welp 1Darren Martin Darren Martin 1Disebo Potloane Disebo Potloane 3Monalisa Manhanzva Monalisa Manhanzva 1Moses M Obimbo Moses M Obimbo 5Katherine Gill Katherine Gill 1,6Mellissa Le Fevre Mellissa Le Fevre 6Anna-Ursula Happel Anna-Ursula Happel 1,7Heather Beryl Jaspan Heather Beryl Jaspan 1,7,8Margaret Kasaro Margaret Kasaro 9Elizabeth A Bukusi Elizabeth A Bukusi 10,4
  • 1 Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
  • 2 National Health Laboratory Service, Cape Town, South Africa
  • 3 Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
  • 4 Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
  • 5 University of Nairobi, Nairobi, Nairobi, Kenya
  • 6 Desmond Tutu HIV Centre, Cape Town, South Africa
  • 7 Division of Immunology, Faculty of Health Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
  • 8 Seattle Children's Research Institute, Seattle, Washington, United States
  • 9 North Carolina Institute for Public Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
  • 10 Departments of Global Health and Obstetrics and Gynaecology, University of Washington, Seattle, United States

The final, formatted version of the article will be published soon.

    Purpose of review: Women in Africa bear the burden of the HIV epidemic, which has been associated with the high prevalence of bacterial vaginosis (BV) in the region. However, little progress has been made in finding an effective cure for BV. Drawing on advances in microbiome-directed therapies for gastrointestinal disorders, similar live-biotherapeutic based approaches for BV treatment are being evaluated. Here, we summarize current knowledge regarding vaginal microbiota in BV, explore geographical differences in vaginal microbiota, and argue that novel BV therapeutics should be tailored specifically to meet the needs of African women.Cervicovaginal microbiota dominated by Lactobacillus crispatus are optimal, although these are uncommon in African women. Besides socio-behavioural and environmental influences on the vaginal microbiota, host and microbial genetic traits should be considered, particularly those relating to glycogen metabolism. Novel microbiome-directed approaches being developed to treat BV should employ transfers of multiple microbial strains to ensure sustained colonization and BV cure.Summary: Improving the efficacy and durability of BV treatment with microbiome-directed therapies by appropriately accounting for host and microbial genetic factors, could potentially reduce the risk of HIV infection in African women.

    Keywords: female, bacterial vaginosis, HIV, Inflammation, Probiotics, Geography, host genetics, Africa

    Received: 11 May 2024; Accepted: 11 Nov 2024.

    Copyright: © 2024 Passmore, Ngcapu, Gitome, Kullin, Welp, Martin, Potloane, Manhanzva, Obimbo, Gill, Fevre, Happel, Jaspan, Kasaro and Bukusi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Jo-Ann S Passmore, Institute of Infectious Diseases and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, Western Cape, South Africa

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.