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J Infect Dis. 2017 Feb 15;215(4):590-598. doi: 10.1093/infdis/jiw590.

Genital Injury Signatures and Microbiome Alterations Associated With Depot Medroxyprogesterone Acetate Usage and Intravaginal Drying Practices.

Author information

1
National HIV and Retrovirology Labs, JC Wilt Infectious Disease Research Centre, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
2
Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.
3
Departments of Global Health and Epidemiology, University of Washington, Seattle, Washington, USA.
4
Affinity Proteomics, SciLife Lab, School of Biotechnology, KTH-Royal Institute of Technology, Stockholm, Sweden.
5
Kenya Medical Research Institute, Nairobi, Kenya
6
Department of Obstetrics and Gynecology, University of Nairobi, Kenya.
7
Department of Medicine, University of Washington, Seattle, USA.
8
Department of Medicine, Solna, Unit of Infectious Diseases, Center for Molecular Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.

Abstract

Background:

Increasing evidence suggests depot medroxyprogesterone acetate (DMPA) and intravaginal practices may be associated with human immunodeficiency virus (HIV-1) infection risk; however, the mechanisms are not fully understood. This study evaluated the effect of DMPA and intravaginal practices on the genital proteome and microbiome to gain mechanistic insights.

Methods:

Cervicovaginal secretions from 86 Kenyan women, including self-reported DMPA users (n = 23), nonhormonal contraceptive users (n = 63), and women who practice vaginal drying (n = 46), were analyzed using tandem-mass spectrometry.

Results:

We identified 473 human and 486 bacterial proteins from 18 different genera. Depot medroxyprogesterone acetate use associated with increased hemoglobin and immune activation (HBD, HBB, IL36G), and decreased epithelial repair proteins (TFF3, F11R). Vaginal drying associated with increased hemoglobin and decreased phagocytosis factors (AZU1, MYH9, PLAUR). Injury signatures were exacerbated in DMPA users who also practiced vaginal drying. More diverse (H index: 0.71 vs 0.45; P = .009) bacterial communities containing Gardnerella vaginalis associated with vaginal drying, whereas DMPA showed no significant association with community composition or diversity.

Conclusions:

These findings provide new insights into the impact of DMPA and vaginal drying on mucosal barriers. Future investigations are needed to confirm their relationship with HIV risk in women.

KEYWORDS:

DMPA; Depot medroxyprogesterone acetate; HIV; Mucosa; genital injury; metaproteome; microbiome; progestin; proteomics; vaginal drying

PMID:
28011908
PMCID:
PMC5388302
DOI:
10.1093/infdis/jiw590
[Indexed for MEDLINE]
Free PMC Article

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