Association of Sex Work With Reduced Activation of the Mucosal Immune System

Background. Unprotected intercourse and seminal discharge are powerful activators of the mucosal immune system and are important risk factors for transmission of human immunodeficiency virus (HIV). This study was designed to determine if female sex work is associated with changes in the mucosal immunity. Methods. Cervicovaginal lavage and plasma from 122 HIV-uninfected female sex workers (FSW) and 44 HIV-uninfected low-risk non-FSW from the same socioeconomic district of Nairobi were analyzed for evidence of immune activation (IA). The cervico-mononuclear cells (CMC) were analyzed for cellular activation by flow cytometry. Results. Lower IA was observed in FSW compared to the low-risk women as demonstrated by the lower level of MIP-3 alpha (P < .001), ITAC (P < .001), MIG (p.0001), IL-1 alpha (P < .001), IL-1 beta (P < .001), IL-1R alpha (P = .0002), IL-6 (P < .001), IL-8 (P < .001), IL-10 (P = .01), IP-10 (P = .0001), MDC (P < .001), MIP-1 alpha, (P < .001), MIP-1 beta (P = .005), MCP-1 (P = .03), and TNF-alpha (P = .006). Significant differences were noted as early as 1 year following initiation of sex work and increased with duration of sex work. Conclusion. This study showed that sex work is associated with important changes in the mucosal immune system. By analyzing chemokine/cytokine levels and CMC activation, we observed a lower mucosal IA in HIV-uninfected FSW compared to low-risk women.