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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Vaginal microbiome, antiretroviral concentrations, and HIV genital shedding in the setting of hormonal contraception initiation in Malawi
AIDS, Volume 37, No. 14, Year 2023
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Description
Objective:The aim of this study was to understand how vaginal microbiota composition affects antiretroviral concentrations in the setting of hormonal contraception initiation.Methods:Cervicovaginal fluid (CVF) concentrations of tenofovir, lamivudine, and efavirenz from 73 Malawian women with HIV were compared before and after initiation of depot-medroxyprogesterone acetate (DMPA) or levonorgestrel implant. We evaluated antiretroviral concentrations and vaginal microbiota composition/structure in the context of contraception initiation and predicted genital shedding using multivariable repeated measurements models fit by generalized estimating equations.Results:Mean lamivudine CVF concentrations decreased 37% 1month after contraception initiation. Subgroup analyses revealed a 41% decrease in women 1month after initiating levonorgestrel implant, but no significant difference was observed in DMPA group alone. Tenofovir, lamivudine, and efavirenz CVF concentrations were positively correlated with anaerobic bacteria associated with nonoptimal vaginal microbiota. Risk of genital HIV shedding was not significantly associated with tenofovir or lamivudine CVF concentrations [tenofovir relative risk (RR): 0.098, P=0.75; lamivudine RR: 0.142, P=0.54]. Lack of association between genital HIV shedding and efavirenz CVF concentrations did not change when adjusting for vaginal microbiota composition and lamivudine/tenofovir CVF concentrations (RR: 1.33, P=0.531).Conclusion:No effect of hormone initiation on genital shedding provides confidence that women with HIV on either DMPA or levonorgestrel implant contraception will not have compromised ART efficacy. The unexpected positive correlation between antiretroviral CVF concentrations and certain bacterial taxa relative abundance requires further work to understand the mechanism and clinical relevance. © 2023 Lippincott Williams and Wilkins. All rights reserved.
Authors & Co-Authors
Cottrell, MacKenzie Leigh
United States, Seattle
School of Pharmacy
Corbett, Amanda H.
United States, Seattle
School of Pharmacy
Chinula, Lameck
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Kourtis, Athena P.
United States, Atlanta
Centers for Disease Control and Prevention
Nelson, Julie A.E.
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Tegha, Gerald L.
Malawi, Lilongwe
Unc Project-malawi
Hurst, Stacey A.
United States, Atlanta
Centers for Disease Control and Prevention
Gajer, Paweł M.
United States
Institute for Genome Sciences
United States, Baltimore
University of Maryland School of Medicine
Ravel, Jacques
United States
Institute for Genome Sciences
United States, Baltimore
University of Maryland School of Medicine
Haddad, Lisa Blake
United States, Atlanta
Emory University School of Medicine
United States, New York
The Population Council, Inc.
Tang, Jennifer Hui Yu
United States, Chapel Hill
The University of North Carolina at Chapel Hill
Nicol, Melanie R.
United States, Minneapolis
University of Minnesota Twin Cities
Statistics
Authors: 12
Affiliations: 9
Identifiers
Doi:
10.1097/QAD.0000000000003686
ISSN:
02699370
Research Areas
Infectious Diseases
Sexual And Reproductive Health
Study Locations
Malawi
Participants Gender
Female