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Inflammatory Marker and Immune Upsets
After Single Forced Vaginal Penetration
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10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City
Mark Mascolini
Levels of IL-1alpha, an inflammation marker, proved higher in the reproductive tract of women who reported a single recent episode of forced vaginal penetration than in women who did not [1]. Levels of TSP-1, which has anti-HIV activity, were lower in women who endured recent sexual violence.
George Washington University researchers who conducted this case-control study noted that dual epidemics of violence and HIV infection affect women across the world, sometimes synergistically. Previous work by this team found that chronic sexual violence can unbalance the immune system of women and so perhaps affect HIV risk [2]. The new analysis aimed to determine whether a single instance of sexual violence can upset the immune microenvironment of the female reproductive tract in ways that heighten HIV risk.
In the Washington, DC area, researchers identified 13 cases (women who reported forced vaginal penetration in the previous 98 days) and 25 controls (women with no history of forced sex). They collected relevant demographics, sexual and reproductive history, and cervicovaginal lavage samples in which they measured markers of inflammation, anti-HIV activity, and wound healing. Women completed the CES-D test to provide a depressive symptom score.
Cases and controls were similar in median age at 28 and 26, while cases included a higher proportion of blacks (61.5% versus 20%) and a higher proportion with public insurance (61.5% versus 32%). The CES-D depression score was significantly higher (worse) in cases than controls (13 versus 4, P = 0.001), and higher proportions of cases ever experienced physical abuse (61.5% versus 0%) or emotional abuse (84.6% versus 16%, P < 0.001). Bacterial vaginosis affected a higher proportion of cases than controls (69.2% versus 8%, P < 0.001).
Compared with controls, cases had significantly lower median levels of the chemokines MIP-3alpha (0.93 log pg/mL lower, P = 0.003) and MCP-1 (1.6 log pg/mL lower, P < 0.001) in cervicovaginal fluid. These chemokines play roles in recruiting lymphocytes (MIP-3alpha) and monocytes (MCP-1). Cervicovaginal levels of the anti-HIV marker TSP-1 were 1.9 log pg/mL lower in women who endured recent forced vaginal penetration (P = 0.03). The inflammation marker IL-1alpha was 0.5 log pg/mL higher in cervicovaginal fluid of cases than controls (P < 0.001), and cases were 11.7 times more likely than controls to have detectable levels of the wound-healing marker PDGF (P < 0.01).
While lower MIP-3alpha and MCP-1 could reduce numbers of HIV target cells, the researchers observed, reduced levels may promote HIV infection by boosting the risk of sexually transmitted infections or bacterial vaginosis. Lower concentrations of the anti-HIV factor TSP-1, they added, may point to loss of innate immune protection against the virus. Genital tract inflammation signaled by higher levels of IL-1alpha could favor HIV replication and seroconversion - may be impacted by the trauma during the event creating a dysregulated microenvironment. Higher levels of PDGF, the wound-healing factor, could signal a lengthy healing process in women who experienced forced vaginal penetration a median of 42 days earlier.
The George Washington team stressed that their small study demonstrates the feasibility of conducting sophisticated immunobiological research in a vulnerable population--women victimized by sexual violence.
References
1. Joy C, Daniels J, Aldous A, et al. Women exposed to recent sexual violence show increased inflammatory and decreased anti-HIV biomarkers in the reproductive tract. 10th IAS Conference on HIV Science (IAS 2019), July 21-24, 2019, Mexico City. Abstract MOPEA020.
2. Ghosh M, Daniels J, Pyra M, et al. Impact of chronic sexual abuse and depression on inflammation and wound healing in the female reproductive tract of HIV-uninfected and HIV-infected women. Plos One. 2018;13:e0198412.
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