The majority of HIV-1 infections result from heterosexual transmission and are established by a single viral variant known as a transmitter/founder (T/F) virus. A major risk factor for HIV infection in women is bacterial vaginosis (BV), an imbalance in vaginal microflora. BV alters the pH (>4.5) and short chain fatty acid (SCFA) profile to predominantly acetic acid (BV) vs lactic acid (non-BV). Interestingly, BV in HIV positive women increases HIV acquisition in their male partners by ~3-fold. It is hypothesized that increased vaginal pH and loss of virucidal lactic acid enable the survival of HIV being shed in the female reproductive tract (FRT), enabling transmission from female-to-male and/or mother-to-child, during vaginal birth. Here, we investigate the susceptibility of female-to-male transmitted subtype C T/F and non-transmitted donor strains to vaginal SCFAs.
Virucidal activity of physiologically relevant SCFAs, at the same pH and active protonated concentrations, were assessed against subtype B and C strains. These included the T/F strain Z3618M, from the male recipient, and matched non-transmitted donor clones Z3618F_5, Z3618F_6, Z3618F_11 and Z3618F_15, with a range of particle infectivities.
Lactic acid exhibited potent virucidal activity against all HIV-1 strains, relative to BV-associated SCFAs. Representative subtype B T/Fs (RHPA and CH058) and subtype C Z3618M_T/F were less susceptible to inactivation by all vaginal SCFAs, showing a 2-log reduction in infectivity. In contrast, treatment of non-transmitted HIV-1 subtypes B and C resulted in a 4-log reduction in virus infectivity or complete inactivation.
We show that lactic acid, a non-BV SCFA, is a more potent HIV virucide than SCFAs produced during BV, suggesting that BV-associated SCFAs are not as protective for the FRT. The reduced susceptibility of T/F strains to vaginal SCFAs may be a trait that enables the survival of HIV-1 shed into the FRT and increases transmission probability from female-to-male and/or mother-to-child.