Immunology of Hiv and Pregnancy

Landers, Daniel V.; Tejada, Begoña Martínez de; Coyne, Bonnie A.

doi:10.1016/s0889-8545(05)70346-6

Cited by 20 publications

(3 citation statements)

References 35 publications

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“…Differences in the impact of pregnancy on HIV disease across geographic areas may reflect differences in potential confounding factors, such as poverty, nutrition, other concurrent infections, and greater likelihood of advanced HIV disease at the time of pregnancy. Cellular immunity and CD4+ lymphocyte levels are expected to decline during pregnancy in all women but eventually return to prepregnancy levels [77]. …”

Section: Human Immunodeficiency Virus (Hiv) Infectionmentioning

confidence: 99%

Pregnancy and Susceptibility to Infectious Diseases

Sappenfield

Jamieson

Kourtis

2013

Infectious Diseases in Obstetrics and Gynecology

248

142

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To summarize the literature regarding susceptibility of pregnant women to infectious diseases and severity of resulting disease, we conducted a review using a PubMed search and other strategies. Studies were included if they reported information on infection risk or disease outcome in pregnant women. In all, 1454 abstracts were reviewed, and a total of 85 studies were included. Data were extracted regarding number of cases in pregnant women, rates of infection, risk factors for disease severity or complications, and maternal outcomes. The evidence indicates that pregnancy is associated with increased severity of some infectious diseases, such as influenza, malaria, hepatitis E, and herpes simplex virus (HSV) infection (risk for dissemination/hepatitis); there is also some evidence for increased severity of measles and smallpox. Disease severity seems higher with advanced pregnancy. Pregnant women may be more susceptible to acquisition of malaria, HIV infection, and listeriosis, although the evidence is limited. These results reinforce the importance of infection prevention as well as of early identification and treatment of suspected influenza, malaria, hepatitis E, and HSV disease during pregnancy.

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Section: Human Immunodeficiency Virus (Hiv) Infectionmentioning

confidence: 99%

Pregnancy and Susceptibility to Infectious Diseases

Sappenfield

Jamieson

Kourtis

2013

Infectious Diseases in Obstetrics and Gynecology

248

142

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“…Cellular immunity and CD4 + lymphocyte levels are expected to decline during pregnancy in all women but eventually return to prepregnancy levels. 31 In a pooled analysis of 4 studies, 3,9,11,12 HIV-infected pregnant women exposed to no or partial ART had marginally increased risk (1.41, 95% CI: 0.99 to 2.02) of progressing to a low CD4 + T-cell count compared with nonpregnant HIV-infected women. 1 Although these studies counted the postpartum period in the pregnancy person-time, other studies have compared the prepregnancy, pregnancy, and postpartum periods and found that CD4 + T-cell count declines during pregnancy are temporary effects, likely due to physiologic effects of pregnancy, and rebound in the postpartum period.…”

Section: Discussionmentioning

confidence: 99%

Effect of Pregnancy on Response to Antiretroviral Therapy in HIV-Infected African Women

Kourtis

Wiener²,

King

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background:While most recent evidence does not support a role for pregnancy in accelerating HIV disease progression, very little information is available on the effects of incident pregnancy in response to antiretroviral therapy (ART). Hormonal, immune, and behavioral changes during pregnancy may influence response to ART. We sought to explore the effects of incident pregnancy (after ART initiation) on virologic, immunologic, and clinical response to ART.Methods:Data were collected from HIV-infected women participating in 3 prospective studies (Partners in Prevention Herpes simplex virus/HIV Transmission Study, Couples Observational Study, and Partners Preexposure Prophylaxis Study) from 7 countries in Africa from 2004 to 2012. Women were included in this analysis if they were ≤45 years of age, were started on ART during the study and were not pregnant at ART initiation. Pregnancy was treated as a time-dependent exposure variable covering the duration of pregnancy, including all pregnancies occurring after ART initiation. Virologic failure was defined as a viral load (VL) greater than 400 copies per milliliter ≥6 months after ART initiation and viral suppression was defined as VL ≤400 copies per milliliter. Multivariable Cox proportional hazards models were used to assess the association between pregnancy and time to viral suppression, virologic failure, World Health Organization clinical stage III/IV, and death. Linear mixed-effects models were used to assess the association between pregnancy and CD4+ count and VL. All analyses were adjusted for confounders, including pre-ART CD4+ count and plasma VL.Results:A total of 1041 women were followed, contributing 1196.1 person-years of follow-up. Median CD4+ count before ART initiation was 276 cells per cubic millimeter (interquartile range, 209–375); median pre-ART VL was 17,511 copies per milliliter (interquartile range, 2480–69,286). One hundred ten women became pregnant after ART initiation. Pregnancy was not associated with time to viral suppression (adjusted hazard ratio [aHR], 1.20, 95% confidence interval [CI]: 0.82 to 1.77), time to virologic failure (aHR, 0.67, 95% CI: 0.37 to 1.22), time to World Health Organization clinical stage III or IV (aHR, 0.79, 95% CI: 0.19 to 3.30), or time to death (aHR, 2.04, 95% CI: 0.25 to 16.8). Incident pregnancy was associated with an adjusted mean decrease in CD4+ T-cell count of 47.3 cells per cubic millimeter (P < 0.001), but not with difference in VL (P = 0.06).Conclusions:For HIV-infected women on ART, incident pregnancy does not affect virologic control or clinical HIV disease progression. A modest decrease in CD4+ T-cell count could be due to physiologic effects of pregnancy.

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“…For example, TLR-3 stimulation followed by the trophoblast producing IFN-b and secretory leukocytes inhibits the vertical transmission of viral infection. Since HIV interferes with the functions of many of these immune cells [21], the maternofetal interface's protection might be breached and allows the entry/co-transmission of HCV and eventually its replication and release. [22]).…”

Section: Introductionmentioning

confidence: 99%

Direct-Acting Antiviral Agents in Prevention of Maternal–Fetal Transmission of Hepatitis C Virus in Pregnancy

Hartley,

Van,

Karnsakul

2024

Pathogens

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Prior to the Food and Drug Administration approval of ledipaspavir/sofosbuvir (Harvoni®) in 2014, the treatment of hepatitis C was interferon plus or minus ribavirin. This treatment had low cure rates for hepatitis C virus and was teratogenic and therefore avoided in pregnant patients. Vertical transmission is the most common transmission of hepatitis C in pediatric patients, whereas medical equipment that was not properly cleaned and sterilized, blood products which were not checked (historically), sharing and reusing syringes and needles, and dialysis are the most common forms of hepatitis C transmission in adults. The treatment of pregnant women with direct-acting antivirals is important because the treatment of pediatric patients cannot begin until three years of age and does not always occur prior to the symptom development of hepatitis C. This review article will include glecaprevir/pibrentasvir (Mayvret®), sofosbuvir/velpatasvir (Epclusa®), and sofosbuvir/velpatasvir plus voxilaprevir (Vosevi®). We aim to review the teratogenic risk of direct-acting antivirals as well as currently published clinical trials and ongoing research on direct-acting antiviral hepatitis C treatment in pregnancy in this publication.

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Immunology of Hiv and Pregnancy

Cited by 20 publications

References 35 publications

Pregnancy and Susceptibility to Infectious Diseases

Pregnancy and Susceptibility to Infectious Diseases

Effect of Pregnancy on Response to Antiretroviral Therapy in HIV-Infected African Women

Direct-Acting Antiviral Agents in Prevention of Maternal–Fetal Transmission of Hepatitis C Virus in Pregnancy

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