Women and girls represent a key population driving new HIV infections and persistence of the HIV pandemic. A key determinant of HIV susceptibility is the composition of the vaginal microbiome, which can influence the local immune cell population, inflammation status, and HIV prevention drug levels. While a low-diversity composition dominated by Lactobacillus crispatus is associated with a decreased risk of HIV acquisition, high diversity environments associated with bacterial vaginosis increase risk of HIV. Given the important role of the vaginal microbiome in determining HIV susceptibility, altering the microbiome towards a Lactobacillus-dominated state is an attractive complementary strategy to reduce HIV incidence rates. Here, we provide an overview of the mechanisms by which the vaginal microbiome may contribute to HIV acquisition risk. Furthermore, we address the advantages and limitations of historical treatments and emerging technologies under investigation to modify the vaginal microbiome, including: antibiotics, bacteriophages, probiotics, topicals, and engineered bacteria. By addressing the current state of vaginal microbiome knowledge and strategies for manipulation, we hope to amplify the growing calls for increased resources and research into vaginal microbial health, which will be essential to accelerating preventative efforts amongst the world’s most vulnerable populations.

妇女和女孩是推动新的艾滋病毒感染和艾滋病毒大流行持续的关键人群。HIV 易感性的一个关键决定因素是阴道微生物组的组成，它可以影响局部免疫细胞群、炎症状态和 HIV 预防药物水平。虽然以卷曲乳杆菌为主的低多样性成分与 HIV 感染风险降低有关，但与细菌性阴道病相关的高多样性环境会增加 HIV 感染风险。鉴于阴道微生物组在确定 HIV 易感性方面的重要作用，将微生物组改变为乳酸杆菌主导状态是降低 HIV 发病率的一个有吸引力的补充策略。在这里，我们概述了阴道微生物组可能导致 HIV 感染风险的机制。此外，我们还讨论了历史治疗和正在研究的新兴技术的优势和局限性，以改变阴道微生物组，包括：抗生素、噬菌体、益生菌、局部用药和工程菌。通过解决阴道微生物组知识和操作策略的现状，我们希望扩大对增加资源和研究阴道微生物健康的日益增长的呼声，这对于加速世界上最脆弱人群的预防工作至关重要。