The Effect of Oral and Topical Antibiotics on Foreskin Inflammation and HIV Target Cells in Ugandan Men.
Abstract
Penile circumcision reduces HIV susceptibility by up to 60% in men; however, many men prefer to remain uncircumcised for personal or cultural reasons. Penile circumcision protects against HIV by reducing anaerobic bacteria on the penis. Penile anaerobes cause local inflammation and the recruitment of HIV-susceptible CD4+CCR5+ cells, increasing the likelihood that exposure to HIV during intercourse results in infection. To determine if a non-surgical intervention can reduce penile anaerobes and HIV target cells, we randomized men to antimicrobial treatment prior to circumcision. To be able to quantify the effect of antimicrobials, we developed a novel deep-learning algorithm to quantify HIV target cells in immunofluorescent microscopy images of foreskin. We found that men who received antimicrobials had a lower density of HIV target cells, which correlated with reductions in penile anaerobes and secreted inflammatory mediators. These results suggest that microbiome-based interventions could be a potential tool for HIV prevention.