Composition of the Vaginal Microbiome May Alter PrEP's Efficacy

Predominance of non-Lactobacillus bacteria correlated with lower levels of vaginal tenofovir and reduced prophylactic efficacy of tenofovir-based microbicidal gel.

Efficacy data on preexposure prophylaxis (PrEP) in women have been inconsistent. Although adherence is a major determinant of PrEP's effectiveness, little is known about biological factors that may exert influence. Vaginal microbiomes fall into two groups: Lactobacillus-dominant (LD; >90% Lactobacillus species) and non-Lactobacillus-dominant (non-LD; <30% Lactobacillus species; abundant Gardnerella vaginalis and other bacteria). Bacterial vaginosis, which results when the vaginal microflora shifts from LD to non-LD, has been associated with excess risk for HIV infection — but can this shift also impair the efficacy of microbicides? In a secondary analysis of the CAPRISA (Centre for the AIDS Program of Research in South Africa) 004 trial of …

Reviewing Author

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Carlos del Rio, MD

Disclosures

Grant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug Abuse

Editorial BoardsJAIDS: Journal of Acquired Immune Deficiency Syndromes; Vaccines

Leadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); Infectious Diseases Society of America (Past President)

Composition of the Vaginal Microbiome May Alter PrEP's Efficacy

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Reviewing Author