Background: The epidemics of violence against women and HIV/AIDS act synergistically to adversely and disproportionately impact women''s health. Though the behavioral aspects of this have been well documented, less is known about the immunology that contributes to the increased risk. We have previously shown that women who experience chronic sexual violence may have a dysregulated immune microenvironment in the female reproductive tract (FRT) that may impact their risk to HIV infection. We hypothesized that even a single instance of sexual violence may result in a dysregulated immune microenvironment that can adversely impact HIV risk.
Methods: Following IRB approval, Cases (n=13) who had experienced forced vaginal penetration within the last 90 days and Controls (n=25) who had no history of forced sex, were recruited for this longitudinal study from the Washington DC Metro area from 2014 to 2016. Cervico-vaginal lavage was analyzed by ELISA for inflammatory, anti-inflammatory/anti-HIV and wound healing biomarkers. Differences in levels between Cases and Controls were determined by Wilcoxon and Chi-square tests (R version 3.4.0).
Results: Race distribution among Cases and Controls was significantly different with 60% of Cases being African-Americans. There were no significant differences in age or insurance type between Cases compared to Controls, though cases were more likely to have experienced additional forms of abuse beyond the defining incident of forced vaginal penetration. Cases had significantly decreased levels of the chemokines MIP-3α and MCP-1 in the FRT as well as an increase in levels of IL-1α, an inflammatory biomarker. In addition, Cases were significantly more likely to have detectable levels of the wound healing factor platelet derived growth factor (PDGF). Thrombospondin-1 (TSP-1), which has been shown to have anti-HIV activity, was also significantly lower in Cases.
Conclusions: Increased IL-1α and PDGF among Cases may be impacted by the trauma during the event creating a dysregulated microenvironment. The lower levels of chemokines among Cases also point to a blunted immune function. Additionally, the lower levels of TSP-1, and MIP-3α, both anti-HIV biomarkers, may increase susceptibility to HIV infection. Our data points to potentially adverse immune alterations in women exposed to recent sexual violence.