Genital Tract Infections and Perinatal Transmission of HIV

Abstract

In areas of the world where genital tract infections (GTIs) are common, the prevalence of HIV and the rate of mother‐to‐child transmission (MTCT) of HIV are also high. Although observational studies suggested that GTIs are associated with MTCT of HIV, no controlled clinical trial has confirmed this finding. It is likely that GTIs that cause either discharges or ulcers during pregnancy increase perinatal transmission of HIV. Several potential biological mechanisms might facilitate perinatal transmission. For example, chorioamnionitis, increased viral shedding in cervicovaginal secretions, increased HIV acquisition during pregnancy, inflammatory cytokine production, preterm labor, prolonged rupture of membranes, ascending infection, and increased intrapartum infectious secretions are factors that can be associated with GTIs. Several studies have shown that treating clinical conditions associated with inflammation might alter HIV shedding. It is conceivable that preventing ascending infection or reducing exposure of the infant to infectious material during birth could reduce MTCT. This can possibly be achieved by antimicrobial therapy during pregnancy and intrapartum. Such an approach is practical, is less expensive, and has secondary benefits related to prevention of adverse pregnancy outcomes associated with GTIs. Antibiotics might also complement reductions in MTCT of HIV obtained by antiretrovirals given to the mother around the time of delivery. In addition, antibiotics could reduce infectious causes of morbidity and mortality in infant and mother.

A phase III clinical trial of antibiotics to reduce chorioamnionitis-related perinatal HIV-1 transmission

“…Observational studies from Africa suggested a strong association between chorioamnionitis and MTCTof HIV-1, e.g. odds ratio (OR) of 3.9 in a study from Kenya [2], and between BV during pregnancy and MTCTof HIV-1, OR 2.3 in a study from Malawi [4]. BV is very common among African women, with a prevalence of approximately 50% [5,6].…”

“…Chorioamnionitis, inflammation of the fetal membranes, and bacterial vaginosis (BV), a disturbance in the normal vaginal ecosystem, have been associated with an increased risk of mother-to-child transmission (MTCT) of HIV-1 [1][2][3][4]. Observational studies from Africa suggested a strong association between chorioamnionitis and MTCTof HIV-1, e.g.…”

“Grand Multi Parity Still and Obstetric Challenge”- A Clinical Study of Grand Multi Para in a Tertiary Care Center

“…2,4 Apart from this STI/RTI have been shown to facilitate transmission of HIV. 5,6 Many STIs and RTIs are transmitted to the neonate by vertical transmission, thus exposing the newborn to these dreadful diseases even before birth.…”

Inhibition of Human Immunodeficiency Virus Type 1 by Lactic Acid Bacteria from Human Breastmilk

“…25 HIV transmission is exacerbated by underlying conditions and co-infections that stimulate inflammatory responses in tissues. [26][27][28] Strains of probiotic breastmilk bacteria with both antiviral activity and proven anti-inflammatory effects may therefore be considered advantageous for application in breastfeeding infants exposed to HIV to reduce the risk of virus transmission. 29 While promising in concept, further studies are needed to fully elucidate the mechanism(s) by which breastmilk LAB inhibit the infectivity of HIV-1, by both bacterial cells and soluble microbial products, and to identify those LAB strains with the most significant potential for development as probiotics.…”