Disturbance of the vaginal microbiome and the risk of HIV infection in women: analysis of scientific studies
Women are the core population group responsible for new HIV infections and the persistence of the HIV pandemic. A key determinant of susceptibility to HIV infection is the composition of the vaginal microbiome, which can influence the local immune cell population and inflammation status. While a low diversity microbial composition dominated by Lactobacillus crispatus is associated with a reduced risk of HIV infection, a high microbial diversity environment associated with bacterial vaginosis increases the risk of HIV infection. Given the important role of the vaginal microbiome in determining HIV susceptibility, changing the microbiome towards Lactobacillus spp. dominance is an attractive additional strategy to reduce the incidence of HIV infection. The review provides an analysis of the mechanisms and factors by which the vaginal microbiome can contribute to HIV infection. Most viral infections begin to develop on the mucous membranes. At the same time, the female reproductive tract has a unique susceptibility to viral infection, since tissue-specific immunity must cause rapid antimicrobial responses to pathogens, while maintaining tolerance to spermatozoids. In addition, the vagina is lined with stratified squamous epithelium in which continuous cell turnover occurs, a process that requires cells to differentiate without provoking an inflammatory immune response. This defines a susceptibility unique to women of reproductive age, who are at disproportionate risk of morbidity and mortality associated with viral pathogens such as HIV infection.