The impact of HIV on accelerated aging in the female genital tract: a pilot trial of topical estradiol to improve the vaginal microbiome and symptoms of vaginal atrophy in menopausal women with HIV

HIV may be associated with premature aging in the female genital tract including alterations in the vaginal microbiome and mucosal inflammation, which may increase risk for vaginal atrophy, UTIs and other genital tract infections. This study will determine if HIV is associated with accelerated genital tract aging including earlier and more pronounced changes in the vaginal microbiome and mucosal inflammation in menopausal women living with HIV (WLWH) compared to HIV uninfected menopausal women. We will then test whether vaginal estradiol will improve symptoms and the vaginal microbiome and reduce mucosal inflammation in menopausal WLWH with vaginal atrophy, thereby improving vaginal health and healthspan.