Placental pathology in HIV infection at term: a comparison with HIV‐uninfected women. Issue 5 (16th March 2017)

• Record Type: Journal Article
• Authors: Kalk, Emma; Schubert, Pawel; Bettinger, Julie A.; Cotton, Mark F.; Esser, Monika; Slogrove, Amy; Wright, Colleen A.
• Is Part Of: Tropical medicine & international health. Volume 22:Issue 5(2017)
• Page Start: 604
• Page End: 613
• Publication Date: 2017-03-16
• Subjects: term pregnancy -- placenta -- HIV infection -- histopathology -- low placental weight -- maternal vascular malperfusion; grossesse à terme -- placenta -- infection VIH -- histopathologie -- faible poids placentaire -- mauvaise vascularisation maternelle; embarazo a término -- placenta -- infección por VIH -- histopatología -- bajo peso placentario -- mala perfusión placentaria; Tropical medicine -- Periodicals; Public health -- Periodicals; 616.988
• DOI: 10.1111/tmi.12858
• Languages: English
• ISSNs: 1360-2276

Abstract

Abstract: Objectives: To describe and correlate placental characteristics from pregnancies in HIV‐infected and HIV‐negative women with maternal and infant clinical and immunological data. Methods: Prospective descriptive study of placentas from term, uncomplicated vaginal births in a cohort of HIV‐infected ( n = 120) and HIV‐negative ( n = 103) women in Cape Town, South Africa. Microscopic and macroscopic features were used to determine pathological cluster diagnoses. The majority of HIV‐infected women received some form of drug treatment for the prevention of vertical transmission of HIV. Data were analysed using logistic regression. Results: HIV‐infected women were older (median [IQR] 27.4 years [24–31] vs . 25.8 [23–30]), more likely to be multiparous (81.7% vs . 71.8%) and had lower CD4 counts (median [IQR] 323.5 cells/ml [235–442] vs . 467 [370–656]). There were no differences in gestational age at first antenatal visit or at delivery. The proportion of specimens with placental lesions was similar in both groups (39.2% vs . 44.7%). Half of all samples were below the tenth percentile expected‐weight‐for‐gestation regardless of HIV status. This was unaffected by adjustment for confounding variables. Maternal vascular malperfusion (MVM) was more frequent in HIV infection (24.2% vs . 12.6%; P = 0.028), an association which strengthened after adjustment (aOR 2.90 [95% confidence interval 1.11–7.57]). Otherwise the frequency of individual diagnoses did not differ between the groups on multivariate analysis. Conclusions: In this cohort of term, uncomplicated pregnant women, few differences were observed between the HIV‐infected and uninfected groups apart from MVM. This lesion may underlie the development of hypertensive disorders of pregnancy, which have been observed at higher rates in some HIV‐infected women on ART.