{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:03:03Z","timestamp":1790618583951,"version":"4.1.0"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Rep Immunol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Women in Sub\u2010Saharan Africa experience disproportionately high rates of HIV\u20101 acquisition, a disparity not fully explained by reported sexual behavior or conventional epidemiological risk factors. Increasing evidence implicates the cervicovaginal microbiome, particularly the presence of a Lactobacillus\u2010dominated, lactic\u2010acid\u2010rich environment, as an important biological determinant of susceptibility. This review synthesizes mechanistic, clinical, and epidemiological evidence linking vaginal lactic acid, Lactobacillus\u2010dominated microbiota, bacterial vaginosis, and HIV\u20101 acquisition, with particular emphasis on evidence from African populations. Lactic acid produced by vaginal Lactobacillus spp. exhibits direct anti\u2010HIV\u20101 activity, suppresses bacterial\u2010vaginosis\u2010associated organisms, and contributes to epithelial barrier homeostasis. Conversely, anaerobe\u2010dominated dysbiosis is associated with reduced lactic acid production, epithelial disruption, heightened inflammatory signaling, and increased availability of HIV\u20101 target cells, with African cohorts reporting approximately two\u2010 to four\u2010fold greater HIV\u20101 acquisition risk among women with dysbiotic microbiota. Emerging interventions targeting vaginal microbiota, including Lactobacillus crispatus\u2010based live biotherapeutics, demonstrate potential to restore microbiological homeostasis and reduce bacterial vaginosis recurrence. Collectively, the evidence supports vaginal microbial restoration as a biologically plausible adjunct to HIV\u20101 prevention. However, regionally validated trials, durable microbiome\u2010targeted interventions, scalable diagnostics, and integration with established prevention platforms are needed to determine clinical effectiveness and implementation feasibility in high\u2010burden African settings.<\/jats:p>","DOI":"10.1111\/aji.70326","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:39:51Z","timestamp":1790617191000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Vaginal Lactic Acid and Lactobacillus\u2010Dominated Microbiota in HIV\u20101 Susceptibility: Mechanistic Insights and Implications for Sub\u2010Saharan African Women"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3983-1244","authenticated-orcid":false,"given":"Aziz","family":"Adamu","sequence":"first","affiliation":[{"name":"Department of Biological Sciences University of Environment and Sustainable Development  Somanya Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473\u20103099(09)70021\u20100"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e3283021a37"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030\u2010199813000\u201000019"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1002611107"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41564\u2010022\u201001083\u20102"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3003605"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.67.10.5170\u20105175.1999"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0080074"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2015.04.019"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043802"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/OLQ.0000000000000972"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2013.05.006"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2018.0304"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2015.00164"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2016.12.013"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.1990.6.1433"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/095646249500600409"},{"issue":"8","key":"e_1_2_13_19_1","first-page":"828","article-title":"Inactivation of human Immunodeficiency Virus (HIV) by Low pH and Pepsin","volume":"4","author":"Kempf C.","year":"1991","journal-title":"Journal of Acquired Immune Deficiency Syndromes"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkt156"},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","unstructured":"D.Tyssen Y.\u2010Y.Wang J. 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