HIV Infection Clinical Trial
Official title:
Role of the Balano-preputial Furrow 's Microbiota, in Circumcised Patients or Not, in the Acquisition or Transmission of HIV
The human immunodeficiency virus (HIV) remains at the moment a major public health problem.
The figures currently report 37 million people infected with HIV worldwide, as well as 2
million new infections every year, the majority of which are men who have sex with men (MSM).
HIV research has accounted for more than 335,000 publications on PubMed since its first
description in 1981. However, many questions remain unanswered, especially regarding the risk
factors and protective factors, its transmission and acquisition, during sexual intercourse.
By creating a background on PubMed with the keyword "HIV", we can see that at the end of the
80's, it was already established that male circumcision decreased the risk of transmission of
HIV by 50 to 60%. Multiple hypotheses have been studied to justify this discovery, such as
the reduction of micro-traumatisms, the modification of keratinization, the modification of
penile anatomy induced by foreskin removal. In parallel, the rise of the study of the human
microbiota, which refers to all microorganisms (bacteria, viruses, archaea, fungi and
parasites) living in a specific environment, the human body, and this in a healthy or
pathological situation. There is evidence that the microbiota may be involved in the
pathogenesis of various diseases and may play a major role in the homeostasis of the human
body. This implication has also interested researchers in the field of HIV : the protective
role of circumcision in the acquisition and transmission of HIV has therefore begun to be
studied in terms of the modification of the penile microbiome.
The first studies showed that circumcision had an impact on the abundance of bacteria present
in the penis in humans, and modified the aerobic / anaerobic ratio in favor of the increase
of aerobic bacteria. The first hypothesis was that circumcision played a protective role in
the acquisition and transmission of HIV through a decrease in the diversity of the penile
microbiota and in particular anaerobes.
This discovery was disrupted by the emergence of studies tending to question a microbiota
predisposing to the risk of HIV acquisition in both men and women.
Indeed, it has been shown that certain bacteria (Prevotella, Dialister, ...) could favor the
acquisition of the virus by the attraction in their wake of inflammation cells such as CD4
and Langerhans cells which would facilitate by their presence. , the penetration of the
virus. This hypothesis has been proven in studies of bacterial vaginosis, which is known to
be a risk factor for HIV acquisition and transmission. In 2012, results showed that the loss
of Lactobacillus, in favor of anaerobic increases such as Gardnerella, Atopobium, and
Prevotella, increased this risk against the HIV virus. Similarly, 7 bacteria have recently
been incriminated in this phenomenon of susceptibility to HIV acquisition (Parvimonas,
Gemella asaccharolytica, Mycoplasma hominis, Leptotrichia / Sneathia, Eggerthellaspecies and
Megasphaeraspecies).Being committed to the exploration of the human microbiota in particular
by culture, we propose to extend the knowledge of balano-preputial furrow 's microbiota in
patients infected by HIV or not and supported in department Infectious Diseases. It is in
this context, that a preliminary study carried out at the IHU between January and July 2018
made it possible to describe the existence of variability of the microbiota according to
various criteria such as circumcision, HIV infection and sexual practices.
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