Changes in the Abundance of Lactobacillus Species in Vaginal Discharge From HIV-Positive Women Compared With HIV-Negative Women in Makassar, Indonesia: A Cross-Sectional Study

Objective: Vaginal microbiota play a role in the pathogenesis of sexually transmitted infections. While dysbiosis is known to mediate increased human immunodeficiency virus (HIV) transmission risk, the specific compositional changes of Lactobacillus (L. ) species in HIV-positive women remain poorly characterized, particularly in Southeast Asian populations. This study aimed to determine the variations in abundance of L. species , including L. crispatus , L. gasseri, L. jensenii , and L. iners in the vaginal discharge samples of HIV-positive women compared with HIV-negative women in Makassar, Indonesia. Methods: A cross-sectional study was conducted at Universitas Hasanuddin Makassar Hospital and Dr Wahidin Sudirohusodo Central General Hospital, Makassar, Indonesia, from June 2023 to September 2023. Vaginal discharge samples were collected from HIV-positive and HIV-negative women, and the abundance of vaginal microbiotas were semi-quantitatively measured by their mRNA levels in polymerase chain reaction examination. The data on the abundance of vaginal microbiotas were statistically analyzed using the Mann–Whitney U test and Kruskal–Wallis test. Results: Vaginal discharge samples were collected from 42 HIV-positive women and 42 HIV-negative women, aged 14 to 49 years. There were significant differences in the abundance of L. iners in the vaginal discharge samples between HIV-positive and HIV-negative women (median [interquartile range], 3.50 [5.06] vs. 2.29 [5.85] log 10 DNA copies/mL; P < 0.001), as well as in abundance of L. jensenii (0.66 [1.62] vs. 0 [0.31] log 10 DNA copies/mL; P = 0.029) and L. gasseri (0.87 [2.01] vs. 0 [0] log 10 DNA copies/mL; P < 0.001). In contrast, there was no significant difference in the abundance of L. crispatus in the vaginal discharge samples between HIV-positive and HIV-negative women (0 [0.29] vs. 0 [1.08] log 10 DNA copies/mL; P = 0.350). No significant differences were found in characteristics of the vaginal discharge samples, including appearance, pH, and fungal and bacterial infections, between the 2 groups (all P > 0.05). Conclusion: The most obvious increase in abundance of L. iners was observed in the vaginal discharge samples from HIV-positive women compared with HIV-negative women. These results may provide evidence for the development of species-specific probiotic interventions as an adjunct therapy for HIV infection.