Higher Transplacental Pathogen-Specific Antibody Transfer Among Pregnant Women Randomized to Triple Antiretroviral Treatment Versus Short Course Zidovudine

Bosire, Rose; Farquhar, Carey; Nduati, Ruth; Broliden, Kristina; Luchters, Stanley; Perre, Philippe Van de; Vincenzi, Isabelle De; Merkel, Michele; Wachuka, Veronicah; Mbori‐Ngacha, Dorothy; John‐Stewart, Grace; Lohman-Payne, Barbara; Reilly, Marie

doi:10.1097/inf.0000000000001749

Cited by 16 publications

(11 citation statements)

References 42 publications

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“…Regarding other variables, our data did not show any significant association between CD4 + T cell counts or HIV viral load on cord blood levels and transplacental transfer of antibodies. Even though these results agree with previous studies that did not find any associations ( 29 , 81 , 97 ), other reports describe that lower CD4 + T cell counts and higher HIV viral load lead to a reduction of the transfer of some pathogen-specific antibodies and vaccines such as measles and S. pneumoniae ( 37 , 43 , 98 ). Some studies describe that HIV-infected women receiving ART transferred higher pathogen-specific antibodies than those who were not under ART ( 97 ) or who initiated it during pregnancy ( 99 ).…”

Section: Discussionsupporting

confidence: 92%

Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique

et al. 2021

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Transplacental transfer of antibodies is essential for conferring protection in newborns against infectious diseases. We assessed the impact of different factors, including gestational age and maternal infections such as HIV and malaria, on the efficiency of cord blood levels and placental transfer of IgG subclasses. We measured total IgG and IgG subclasses by quantitative suspension array technology against 14 pathogens and vaccine antigens, including targets of maternal immunization, in 341 delivering HIV-uninfected and HIV-infected mother-infant pairs from southern Mozambique. We analyzed the association of maternal HIV infection, Plasmodium falciparum exposure, maternal variables and pregnancy outcomes on cord antibody levels and transplacental transfer. Our results show that maternal antibody levels were the main determinant of cord antibody levels. Univariable and multivariable analysis showed that HIV reduced the placental transfer and cord levels of IgG and IgG1 principally, but also IgG2 to half of the antigens tested. P. falciparum exposure and prematurity were negatively associated with cord antibody levels and placental transfer, but this was antigen-subclass dependent. Our findings suggest that lower maternally transferred antibodies may underlie increased susceptibility to infections of HIV-exposed infants. This could affect efficacy of maternal vaccination, especially in sub-Saharan Africa, where there is a high prevalence of HIV, malaria and unfavorable environmental factors.

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Section: Discussionsupporting

confidence: 92%

Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique

et al. 2021

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“…Maternal PMTCT regimens and breastfeeding recommendations for HIV-infected mothers varied substantially between 1987 and 2018, and may have contributed to differences between HEU and other groups. Fetal ART exposure has been associated with less hypergammaglobulinemia in HEU children [107] and higher transfer of transplacental pathogen-specific antibodies was reported in women on triple ART compared with women on short course zidovudine [108]. In this meta-analysis, only two studies reported on maternal ART [61], [100] and one on breastfeeding [100]; no association with measles seroresponse was found.…”

Section: Discussionmentioning

confidence: 67%

Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

et al. 2018

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Background HIV-infected and HIV-exposed uninfected (HEU) children have an increased risk of measles that may be due to altered immune responses or suboptimal timing of measles vaccination. We aimed to evaluate the safety and immunogenicity of measles vaccination in HIV-infected and HEU children. Methods For this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Library, CINAHL, Global Health Library and IndMED on May 9, 2018. Studies were included if they reported on safety or seroresponse (either seroprotection/seropositivity/seroconversion) after measles vaccination in HIV-infected or HEU children. We calculated pooled estimates to compare immunogenicity outcomes between HIV-infected, HEU and HIV-unexposed children, using risk ratios [RRs] (with 95%CIs). PROSPERO registration number: CRD42017057411. Findings Seventy-one studies met the inclusion criteria (15,363 children). Twenty-eight studies reported on safety; vaccine-associated adverse events and deaths were uncommon. Sixty-two studies reported on immunogenicity, 27 were included in the meta-analysis. HIV-infected children had lower seroresponse rates after primary vaccination compared with HIV-unexposed (RR 0.74; 95%CI: 0.61–0.90, I 2 = 85.9%) and HEU children (0.78; 0.69–0.88, I 2 = 77.1%), which was mitigated by antiretroviral therapy and time interval between vaccination and serology. HEU and HIV-unexposed children had similar seroresponses. Vaccination at 6-months resulted in similar proportions of HIV-infected children having seroresponse compared with HIV-unexposed (0.96; 0.77–1.19) and HEU children (1.00; 0.73–1.37, I 2 = 63.7%). Interpretation Primary measles vaccination at 6-months of age may provide protection against measles during early infancy in settings with high prevalence of maternal HIV-infection, however, further studies are needed to evaluate this strategy in HEU children and HIV-infected children receiving antiretroviral therapy. Funding South African Research Chairs Initiative of the Department of Science and Technology and National Research Foundation in Vaccine Preventable Diseases; Medical Research Council: Respiratory and Meningeal Pathogens Research Unit.

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“…Most of these studies were conducted before widespread ART. Bosire et al found that transplacental transfer of antibodies against measles, pneumococcus, and rotavirus was higher in HIV+ women on triple ART compared with HIV+ women on short-course zidovudine alone, underscoring the positive impact of optimal ART [42]. Recent studies have examined transplacental antibody transfer in HIV+ women treated with more optimal ART in pregnancy and found persistent reduced CMR to respiratory syncytial virus (RSV) and GBS compared with HIV- women [43–45].…”

Section: Discussionmentioning

confidence: 99%

Reduced Transplacental Transfer of Antimalarial Antibodies in Kenyan HIV-Exposed Uninfected Infants

Ray

Dobbs

Ogolla

et al. 2019

Open Forum Infectious Diseases

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Background Altered neonatal immune responses may contribute to the increased morbidity observed in HIV-exposed but uninfected (HEU) infants compared with HIV-unexposed uninfected (HUU) infants. We sought to examine the effects of prenatal HIV and malaria exposure on maternal and neonatal plasma cytokine profiles and transplacental antibody transfer. Methods Forty-nine HIV+ and 50 HIV- women and their HIV-uninfected neonate pairs from Kenya were assessed. All HIV+ mothers received combination antiretroviral therapy. Maternal plasma and cord blood plasma samples at delivery were tested for 12 cytokines, total IgG, and IgG specific to 4 vaccine antigens and 14 Plasmodium falciparum antigens. Results HIV+ mothers had lower levels of all 12 plasma cytokines at delivery compared with HIV- mothers, but there were no differences between HEU and HUU neonates. There were no differences in the cord-to-maternal ratios (CMRs) of vaccine-specific IgG between HIV+/HEU and HIV-/HUU maternal–neonate pairs. HIV+/HEU maternal–neonate pairs had significantly lower CMRs for 3 antimalarial IgGs—merozoite surface protein 9, circumsporozoite protein, and erythrocyte binding antigen 181—which remained statistically significant after adjustment for malaria in pregnancy. Conclusions In a cohort of optimally treated HIV-infected pregnant women, maternal HIV infection was associated with reduced transplacental transfer of antimalarial antibodies.

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Higher Transplacental Pathogen-Specific Antibody Transfer Among Pregnant Women Randomized to Triple Antiretroviral Treatment Versus Short Course Zidovudine

Abstract: Women on triple ART transferred higher levels of pathogen-specific antibodies compared with women on ZDV alone.

Cited by 16 publications

References 42 publications

Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique

Reduced Placental Transfer of Antibodies Against a Wide Range of Microbial and Vaccine Antigens in HIV-Infected Women in Mozambique

Safety and Immunogenicity of Measles Vaccination in HIV-Infected and HIV-Exposed Uninfected Children: A Systematic Review and Meta-Analysis

Reduced Transplacental Transfer of Antimalarial Antibodies in Kenyan HIV-Exposed Uninfected Infants

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