In a recent study conducted in Lilongwe, Malawi, researchers investigated how antiretroviral drugs (ARVs) used for HIV treatment and prevention affect the vaginal microbiome of pregnant women and the associated risk of spontaneous preterm birth (sPTB).
Study Participants and Methodology
The study encompassed 255 pregnant women, of whom 64 were living with HIV (WLHIV) and 191 were HIV-negative. WLHIV initiated antiretroviral therapy (ART), while HIV-negative participants began oral pre-exposure prophylaxis (PrEP). Baseline vaginal swabs were collected from all participants, and follow-up samples were obtained from 181 women one month after ARV initiation. The diversity and composition of the vaginal microbiome were analyzed, focusing on the presence of Lactobacillus and other microbial communities.
Impact of ARVs on Vaginal Microbiome Diversity
Initial findings revealed that WLHIV exhibited higher Shannon diversity in their vaginal microbiome and were more likely to possess a community state type (CST) IV-B compared to CST I or III. Following ARV initiation, WLHIV experienced a decrease in microbiome diversity, whereas HIV-negative women showed an increase in diversity post-PrEP initiation.
Inferences:
- ARV initiation in WLHIV may lead to a less diverse vaginal microbiome, potentially affecting pregnancy outcomes.
- HIV-negative women on PrEP experience increased microbiome diversity, which might be protective against sPTB.
- Transitioning to CST IV during pregnancy is associated with higher odds of sPTB, irrespective of HIV status.
The study found that women initiating PrEP had a lower risk of experiencing spontaneous preterm birth compared to WLHIV who started ART. However, those who transitioned to CST IV during pregnancy faced increased odds of sPTB. These results highlight the complex relationship between ARV use, vaginal microbiome composition, and pregnancy outcomes.
Extensive research is required to delve deeper into how different ARV regimens influence the vaginal microbiome and to develop strategies that mitigate the risk of preterm births. Understanding these interactions is crucial for improving maternal and neonatal health outcomes, especially in regions with high HIV prevalence.
Healthcare providers should consider the implications of ARV-induced microbiome changes when managing pregnancies in women with HIV. Tailoring ARV therapies to support a healthy vaginal microbiome could be a pivotal step in reducing the incidence of sPTB and enhancing the overall effectiveness of HIV treatments during pregnancy.
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