Transgender women (TGW) are disproportionally affected by HIV infection, with a global estimated prevalence of 19.9%, often attributed to behavioral risk factors, with less known about biological factors. We evaluated potential biological risk factors for HIV acquisition in TGW at the sites of viral entry by assessing immune parameters of the neovaginal surface and gut mucosa. The neovagina in TGW, compared with the vagina in cisgender women (CW), shows distinct cell composition and may pose a more inflammatory environment, evidenced by increased CD4+ T cell activation and higher levels of soluble markers of inflammation (C-reactive protein, soluble CD30). Increased inflammation may be driven by microbiome composition, as shown by a greater abundance of Prevotella and a higher Shannon Diversity Index. In addition, we have observed higher frequency of CD4+CCR5+ target cells and decreased DNA methylation of the CCR5 gene in the gut mucosa of TGW compared with CW and men who have sex with men, which was inversely correlated with testosterone levels. The rectal microbiome composition in TGW appears to favor a proinflammatory milieu as well as mucosal barrier disruption. Thus, it is possible that increased inflammation and higher frequencies of CCR5-expressing target cells at sites of mucosal viral entry may contribute to increased risk of HIV acquisition in TGW, with further validation in larger studies warranted.
Alexandra Schuetz, Michael J. Corley, Carlo Sacdalan, Yuwadee Phuang-Ngern, Thitiyanun Nakpor, Tanyaporn Wansom, Philip K. Ehrenberg, Somchai Sriplienchan, Rasmi Thomas, Nisakorn Ratnaratorn, Suchada Sukhumvittaya, Nipattra Tragonlugsana, Bonnie M. Slike, Siriwat Akapirat, Suteeraporn Pinyakorn, Rungsun Rerknimitr, Alina P.S. Pang, Eugène Kroon, Nipat Teeratakulpisan, Shelly J. Krebs, Nittaya Phanuphak, Lishomwa C. Ndhlovu, Sandhya Vasan, on behalf of the RV304/SEARCH013 Study Team
This file is in Adobe Acrobat (PDF) format. If you have not installed and configured the Adobe Acrobat Reader on your system.
PDFs are designed to be printed out and read, but if you prefer to read them online, you may find it easier if you increase the view size to 125%.
Many versions of the free Acrobat Reader do not allow Save. You must instead save the PDF from the JCI Online page you downloaded it from. PC users: Right-click on the Download link and choose the option that says something like "Save Link As...". Mac users should hold the mouse button down on the link to get these same options.