The Impact of vaginal microbiota on human Papillomavirus infection.
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Date
2022
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Abstract
Background: Cervical human papillomavirus (HPV) infection is the most common sexually
transmitted infection (STI) in sub-Saharan African women of reproductive age. While most
women clear HPV infection, persistent infection with high-risk HPV is the most common nonsystem
biological risk factor for cervical cancer development. Increased levels of proinflammatory
cytokines and overgrowth of diverse microbial communities have been implicated
in undermining the clearance of the infection and promoting oncogenesis. Here we aimed to
evaluate the role of vaginal microbiota composition in the persistence and clearance of HPV
infections in women.
Methods: This study included the assessment of 56 women who participated in the CAPRISA 083
cohort. The CAPRISA 083 study evaluated point of care STI testing immediate treatment and
expedited partner therapy. Sexually transmitted infections (STIs) and BV were screened using the
GeneXpert system or OSOM Trichomonas rapid test and Nugent score, respectively. Vaginal
swabs and SoftCup genital secretions were collected at enrolment, 6 weeks, and 13 weeks posttreatment.
The Roche Linear Array was used for HPV genotyping, and the vaginal microbiome
was characterized using 16S rRNA sequencing.
Results: The study demonstrated a 36/56 (64 %), 28/56 (50 %), and 36/56 (64 %) prevalent of
HPV at baseline, 6 weeks and 13 weeks, respectively. The prevalence of high-risk HPV infection
at baseline was 58%, 61% at 6 weeks, and 45% at 13 weeks. HPV 16, 45, 58, and 59 were the most
dominant high-risk genotypes in all visits, while HPV 6 was the least common. Overall, 46%
(26/56) of participants cleared any HPV genotype, while 45% (25/56) acquired and 38% (21/56)
had persisted any HPV genotype at follow-up visits. Alpha diversity of the vaginal microbiome of
women with HPV (p value= 0.57) and high-risk HPV (p value= 0.6) infection did not differ
significantly to that in vaginal microbiome from uninfected women. LEfSe analysis identified
Lactobacillus spp. (particularly L. iners) as potential biomarkers for HPV clearance between visits,
whereas HPV persistence was associated with enrichment of Sneathia amnii and other BVassociated
bacteria.
Conclusion: While our data do not indicate the causal link between the diverse genital microbiome
and HPV clearance or persistent, L. iners and Sneathia abundance were associated with HPV
clearance and persistent, respectively. These data suggest the need for longitudinal investigation
to confirm a biological mechanism for this relationship, which will likely benefit cervical cancer
management.
Description
Masters Degree. University of KwaZulu-Natal, Durban.