Morphologic changes in the placentas of HIV‐positive women and their association with degree of immune suppression

Vermaak, Anine; Theron, Gerhard; Schubert, Pawel; Kidd, Martin; Rabie, Ursula; Adjiba, Benedict M.; Wright, Colleen A.

doi:10.1016/j.ijgo.2012.06.016

Cited by 23 publications

(9 citation statements)

References 17 publications

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“…However, results were not correlated with CD4 count . A Cape Town hospital‐based study including stillbirths found an increased prevalence of the lesion in women with low CD4 counts but preceded the more effective PMTCT strategies in place during our study. Baurakiades et al ., commenting on the increased numbers of CD8+ T cells observed in the placenta of HIV‐infected women, postulated the presence of an HIV‐specific villitis, distinct from VUE .…”

Section: Discussionmentioning

confidence: 57%

“…We present, to our knowledge, the largest analysis of placentas from a well‐matched group of HIV‐infected and HIV‐negative women experiencing uncomplicated vaginal deliveries at term in a resource‐limited setting . This limits much of the confounding owing to gestational age and obstetric complications seen in hospital‐based populations in other studies , allowing us to generalise to similar healthy populations. Moreover, HIV‐infected and HIV‐negative women were from the same communities and similar in their socio‐economic, behavioural and cultural characteristics, thus further limiting unmeasured confounders.…”

Section: Discussionmentioning

confidence: 99%

“…Most reports fail to identify specific lesions associated with HIV, and direct infection of the placenta is not a requirement for vertical transmission; nor does the presence of virus in placental tissue guarantee foetal infection . Lesions of the chorionic villi noted in the placentas of HIV‐infected women are thought to be immune‐mediated . In addition, ART can alter the local and systemic immunological milieu.…”

Section: Introductionmentioning

confidence: 99%

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Placental pathology in HIV infection at term: a comparison with HIV‐uninfected women

Kalk

Schubert

Bettinger

et al. 2017

Tropical Med Int Health

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Placental pathology in HIV infection at term: a comparison with HIV‐uninfected women

Kalk

Schubert

Bettinger

et al. 2017

Tropical Med Int Health

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“…1 Prenatal exposures to infections, including HIV, may alter fetal and postnatal growth, 2 through decreases in placental size or morphologic changes 3,4 or mitochondrial abnormalities. 5 Little is known about antenatal ARV exposure and growth.…”

Section: Introductionmentioning

confidence: 99%

Growth at 2 Years of Age in HIV-exposed Uninfected Children in the United States by Trimester of Maternal Antiretroviral Initiation

Jacobson

Patel

Williams

et al. 2017

Pediatric Infectious Disease Journal

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Background Abnormal childhood growth may affect future health. Maternal tenofovir (TFV) use was associated with lower body length and head circumference at one year of age in HIV-exposed uninfected (HEU) US children. Methods We studied 509 HEU children in the US-based Surveillance Monitoring of ART Toxicities cohort whose HIV-infected mothers were not using antiretrovirals at the last menstrual period and began combination antiretroviral therapy (cART) in pregnancy (cART-initiators). We examined adjusted associations between antiretrovirals and CDC 2000 growth z-scores at 2 years of age within trimester of cART initiation: weight (WTZ), length (LNZ), weight-for-length (WFLZ), triceps skinfold z-score (TSFZ), and head circumference (HCZ). Results Mothers mean age was 28.6 years; 57% were black non-Hispanic and 19% delivered at <37 weeks gestation. At 2 years, mean WTZ, LNZ, WFLZ, and HCZ, were above average (P<0.05), while TSFZ (P=0.57) did not differ from average. WFLZ was >1.64 SD (>95th percentile) in 13%. Among children of first trimester cART-initiators, TFV+emtricitabine -exposed children had slightly higher mean WFLZ (0.45 SD, 95%CI −0.10, 1.00) and lower TSFZ (−0.55 SD, 95%CI −1.07, −0.02) compared to zidovudine+lamivudine-exposed. TSFZ was lower in those exposed to boosted protease inhibitors. In contrast, growth in children of second trimester cART-initiators did not differ by antiretroviral exposures. Conclusion Growth was above average in HEU; 13% were obese. Maternal TFV use was not associated with lower length or head circumference at age two, as hypothesized, but may be related to greater weight among those exposed to cART early in pregnancy.

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“…Maternal HIV may restrict placental size (7, 8) and cause morphologic changes,(8, 9) leading to deficient nutrient transfer and aberrant fetal metabolism. Metabolic complications from these changes may include compromised intrauterine and postnatal growth from placental insufficiency, poor bone health from decreased vitamin D and calcium transfer, as well as mitochondrial toxicities attributed to ARV exposure.…”

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confidence: 99%

Metabolic Complications of in utero Maternal HIV and Antiretroviral Exposure in HIV-exposed Infants

Jao

Abrams

2014

Pediatric Infectious Disease Journal

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Background Despite a wide body of literature supporting the use of antenatal antiretrovirals (ARV) for the prevention of mother to child transmission, there remains a need for continued monitoring as the intrauterine interval is a critical period during which fetal programming influences the future health and development of the child. Methods We conducted a systematic review of the current literature addressing potential metabolic complications of in utero HIV and ARV exposure. We describe studies evaluating metabolic outcomes such as intrauterine and early postnatal growth, bone health, and mitochondrial toxicity. Results Overall, infants exposed to HIV/ARV do not appear to exhibit vastly compromised intrauterine or early postnatal growth. However, some studies on the effect of combination antiretroviral therapy (cART) on small for gestational age (SGA) and low birth weight (LBW) outcomes in low-middle income countries show a risk for SGA/LBW while those in the U.S. do not. Postnatal growth to 1 year does not appear to be affected by intrauterine tenofovir exposure in African studies, but a U.S. study found statistically significant differences in length for age z scores (LAZ) at 1 year. Little data exists on long term bone health. Mitochondrial toxicity including abnormal mitochondrial morphology and DNA content, as well as neurologic deficits and death have been demonstrated in HIV/ARV–exposed infants. Conclusion Though gross measures of metabolic well-being appear to be reassuring, careful vigilance of even small risks for potential serious adverse effects to infants exposed to intrauterine HIV/ARVs is warranted as intrauterine fetal metabolic programming may substantially impact the future health of the child.

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Morphologic changes in the placentas of HIV‐positive women and their association with degree of immune suppression

Cited by 23 publications

References 17 publications

Placental pathology in HIV infection at term: a comparison with HIV‐uninfected women

Placental pathology in HIV infection at term: a comparison with HIV‐uninfected women

Growth at 2 Years of Age in HIV-exposed Uninfected Children in the United States by Trimester of Maternal Antiretroviral Initiation

Metabolic Complications of in utero Maternal HIV and Antiretroviral Exposure in HIV-exposed Infants

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