Immune responses to vaginal candidiasis in African women: A scoping review of cytokine profiles, T-cell activation, and gene expression

BACKGROUND: Recent immunological studies of vaginal candidiasis in African populations have revealed complex host‒pathogen interactions with implications for therapeutic development and HIV acquisition risk. OBJECTIVE: This scoping review synthesized evidence from Uganda, Zambia, South Africa, and Kenya between 2020 and 2024, focusing on immune responses, cellular dynamics, and tissue effects due vulvovaginal candidiasis. RESULTS: Analysis revealed a coordinated inflammatory response marked by elevated levels of the proinflammatory cytokines IL-1β and IL-6 and increased chemokine IL-8-mediated immune cell recruitment. Compared with those in control individuals, distinct T-cell population patterns in colonized individuals show reduced Th17-like CD4+ T-cell activation, with concurrent increases in Th1/Th2-enriched CD4+ T cells. Molecular analysis revealed that 162 differentially expressed genes were involved primarily in neutrophil-mediated immunity and cytokine signaling pathways. Despite robust immune activation, tissue integrity remained intact, accompanied by elevated antimicrobial peptides SLPI and BD-2. Notably, Candida-colonized individuals presented reduced frequencies of HIV target cells (CCR5 + HLA-DR + CD4 + T cells). CONCLUSION: These findings advance our understanding of population-specific immune responses to vaginal candidiasis and identify promising therapeutic targets, highlighting the need for longitudinal studies to characterize vulvovaginal candidiasis immunopathogenesis fully in African populations.