Hormonal contraception alters vaginal microbiota and cytokines in SA adolescents
Young women are disproportionally affected by HIV and are at high risk of unintended pregnancies. Hormonal contraceptives (HC) are often used to avoid pregnancy; however, these may increase HIV risk through changes in genital tract microbiota and inflammatory cytokines, both of which are associated with HIV acquisition.
To investigate this, the DOI researchers enrolled 130 at-risk, HIV negative adolescent females aged 15–19 years into a substudy of UChoose, an open-label randomized crossover study (NCT02404038), comparing acceptability and contraceptive product preference as a proxy for HIV prevention delivery methods.
The young women were randomized “to either injectable norethisterone enanthate (Net-En), combined oral contraceptives (COC) or etonorgesterol/ethinyl estradiol combined contraceptive vaginal ring (CCVR) for 16 weeks, then crossed over to another HC method for another 16 weeks”.
Dr Balle and her team took cervicovaginal samples at baseline, crossover and exit for characterization of the vaginal bacterial communities and cytokine level measurement. The researchers found that COC users had lower more optimal vaginal microbiota and less HIV risk-associated taxa compared to the Net-En or CCVR adolescents. Cervicovaginal inflammatory cytokine concentrations were significantly higher in adolescents randomized to CCVR compared to COC and Net-En.
The findings suggest that COC use may induce an optimal vaginal ecosystem by decreasing bacterial diversity and inflammatory taxa, while CCVR use is associated with genital inflammation. As such, certain HC may be explored as potential interventions to optimize the vaginal environment.
Read the paper - Hormonal contraception alters vaginal microbiota and cytokines in South African adolescents in a randomized trial
Article by Bonamy Holtak