Project 458318

African, Caribbean, and other Black (ACB) women are at a disproportionately high risk of HIV acquisition, both in Ontario and globally. This may relate in part to variation in the types of bacteria that are present in the female genital tract (FGT), collectively known as the vaginal microbiome. The composition of the vaginal microbiome composition has been linked to multiple reproductive health outcomes, including the risk of HIV acquisition after a sexual exposure. A high diversity of bacterial species in the vaginal microbiome, as opposed to predominance of Lactobacillus species, defines a condition known as bacterial vaginosis (BV). While BV is often asymptomatic, it increases HIV susceptibility and is more common among ACB women. While there is antibiotic treatment for BV, the condition usually recurs within a few months; furthermore, our research group has found that standard antibiotic treatment actually increases some immune indicators of HIV risk. My proposed research aims to test novel microbiome-focused clinical strategies, both antibiotic- and probiotic-based, to reduce HIV susceptibility among ACB women. I hypothesize that standard antibiotic BV treatment will increase certain immune indicators of HIV susceptibility, including indicators of HIV target cell recruitment to the vaginal lining, but that addition of a novel probiotic will restore the vaginal microbiome to a state that is protective against HIV. The elevated HIV risk faced by ACB women emphasizes the urgent need for better clinical strategies to reduce HIV susceptibility among this population. We hope that the results of this proposed research can inform future clinical strategies to reduce HIV susceptibility among women and the ACB community.