Microbial mismanagement: how inadequate treatments for vaginal dysbiosis drive the HIV epidemic in women

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Women and girls represent a key population driving new HIV infections and persistence of the HIV pandemic. A key determinant of HIV susceptibility is the composition of the vaginal microbiome, which can influence the local immune cell population, inflammation status, and HIV prevention drug levels. While a low-diversity composition dominated by Lactobacillus crispatus is associated with a decreased risk of HIV acquisition, high diversity environments associated with bacterial vaginosis increase risk of HIV. Given the important role of the vaginal microbiome in determining HIV susceptibility, altering the microbiome towards a Lactobacillus-dominated state is an attractive complementary strategy to reduce HIV incidence rates. Here, we provide an overview of the mechanisms by which the vaginal microbiome may contribute to HIV acquisition risk. Furthermore, we address the advantages and limitations of historical treatments and emerging technologies under investigation to modify the vaginal microbiome, including: antibiotics, bacteriophages, probiotics, topicals, and engineered bacteria. By addressing the current state of vaginal microbiome knowledge and strategies for manipulation, we hope to amplify the growing calls for increased resources and research into vaginal microbial health, which will be essential to accelerating preventative efforts amongst the world's most vulnerable populations.

Original languageEnglish (US)
Article number101482
JournalSeminars in Immunology
StateE-pub ahead of print - Jan 2021

Bibliographical note

Funding Information:
Authors are supported by NIH funding through grants NIH/NIAID R01AI120712 , NIH/NIDDK RO1DK112254 , NIH/NIDA DP1DA037979 , NIH/NIAID R01AI128782 , NIH/NIDDK R56DK119940 and NIH/NIAID R01AI138718 .

Publisher Copyright:
© 2021


  • Inflammation
  • Microbiome
  • Mucosal immunity
  • Vaginal microbiome
  • Women's health

PubMed: MeSH publication types

  • Review
  • Journal Article
  • Research Support, N.I.H., Extramural


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