Placental pathology in women with HIV

Ikumi, Nadia M.; Matjila, Mushi; Gray, Clive M.; Anumba, Dilly; Pillay, Komala

doi:10.1016/j.placenta.2021.09.006

Cited by 12 publications

(8 citation statements)

References 86 publications

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“…However, even in the absence of vertical transmission, maternal HIV infection is associated with an altered immune landscape in the decidua and villous tissue ( 15 ). In addition, placentae from women with HIV have been shown to have increased features of placental insufficiency including maternal vascular malperfusion, and features of acute and chronic inflammation ( 12 ). Furthermore, HIV exposed uninfected (HEU) neonates have an increased risk of morbidity and mortality, an increased risk of being born preterm and suboptimal behavioral and neurological development compared to their HIV unexposed uninfected (HUU) counterparts ( 46 , 47 ).…”

Section: Hiv Infection At the Maternal Fetal Interfacementioning

confidence: 99%

“…Indeed, several studies have demonstrated the adverse effects HIV/ART can have on the placenta. Placentae from women with HIV have been shown to have increased features of placental insufficiency including maternal vascular malperfusion in addition to acute and chronic inflammation ( 12 ). These patterns of injury have further been associated with adverse birth outcomes such as PTB and available evidence links poor placental function to compromised fetal development ( 13 , 14 ).…”

Section: Introductionmentioning

confidence: 99%

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Preterm Birth in Women With HIV: The Role of the Placenta

Ikumi

Matjila

2022

Front. Glob. Womens Health

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Maternal HIV infection is associated with an increased risk of preterm birth (PTB). However, the mechanisms underlying this increased risk in women with HIV remain poorly understood. In this regard, it is well-established that labor is an inflammatory process and premature activation of the pro-inflammatory signals (associated with labor) can result in preterm labor which can subsequently lead to PTB. HIV infection is known to cause severe immune dysregulation within its host characterized by altered immune profiles, chronic inflammation and eventually, the progressive failure of the immune system. The human placenta comprises different immune cell subsets, some of which play an important role during pregnancy including participating in the inflammatory processes that accompany labor. It is therefore plausible that HIV/antiretroviral therapy (ART)-associated immune dysregulation within the placental microenvironment may underlie the increased risk of PTB reported in women with HIV. Here, we review evidence from studies that point toward the placental origin of spontaneous PTB and discuss possible ways maternal HIV infection and/or ART could increase this risk. We focus on key cellular players in the maternal decidua including natural killer cells, CD4+ T cells including CD4+ regulatory T cells, CD8+ T cells as well as macrophages.

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Section: Hiv Infection At the Maternal Fetal Interfacementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preterm Birth in Women With HIV: The Role of the Placenta

Ikumi

Matjila

2022

Front. Glob. Womens Health

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“…Together, these findings are concerning indicators of possible intrauterine fetal growth restriction, which is a leading global cause of stillbirth, neonatal mortality, and morbidity (8). Furthermore, maternal HIV infection and antiretroviral treatment are associated with MVM, with prevalence as high as 30-40% (21). Large-scale perinatal pathology studies carried out in sSA have also demonstrated associations between utero-placental vascular pathology, acute chorioamnionitis, and stillbirth (22,23).…”

Section: Publications and Other Deliverablesmentioning

confidence: 99%

Building Perinatal Pathology Research Capacity in Sub-Saharan Africa

et al. 2022

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IntroductionOver two million stillbirths and neonatal deaths occur in sub-Saharan Africa (sSA) annually. Despite multilateral efforts, reducing perinatal mortality has been slow. Although targeted pathologic investigation can often determine the cause of perinatal death, in resource-limited settings, stillbirths, early neonatal deaths, and placentas are rarely examined pathologically. However, the placenta is a key source of diagnostic information and is the main determinant of fetal growth and development in utero, influencing child health outcomes.MethodsIn 2016, our collaborative intercontinental group began investigating infectious perinatal death and adverse child health outcomes in Uganda. We developed and initiated a 4-day combined didactic/practical curriculum to train health workers in placental collection, gross placental examination, and tissue sampling for histology. We also trained a local technician to perform immunohistochemistry staining.ResultsOverall, we trained 12 health workers who performed gross placental assessment for > 1,000 placentas, obtaining > 5,000 formalin-fixed tissue samples for research diagnostic use. Median placental weights ranged from 425 to 456 g, and 33.3% of placentas were < 10th percentile in weight, corrected for gestational age. Acute chorioamnionitis (32.3%) and maternal vascular malperfusion (25.4%) were common diagnoses.DiscussionThrough a targeted training program, we built capacity at a university-affiliated hospital in sSA to independently perform placental collection, gross pathologic examination, and placental tissue processing for histology and special stains. Our training model can be applied to other collaborative research endeavors in diverse resource-limited settings to improve research and clinical capacity and competency for diagnostics and management of stillbirth, neonatal death, and child health outcomes.

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“…Gross pathological assessments of placental specimens have identified low placental weight, maternal vascular malperfusion, chorioamnionitis, and placental inflammation relative to HIV infection. 59 , 60 More recently, Kalk et al 61 reported HIV-infection induced a 2.21-fold higher frequency of maternal vascular malperfusion, which can significantly boost the risk of IUGR and fetal demise. Crucially, excessive inflammatory response, disordered immune cell composition, and performance in HIV-1 infected placenta could also directly affect the fetal growth and development leading to babies with low birth weight.…”

Section: Viral Infections During Pregnancymentioning

confidence: 99%

Viral Infections During Pregnancy: The Big Challenge Threatening Maternal and Fetal Health

Cao

2021

Maternal-Fetal Medicine

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Viral infections during pregnancy are associated with adverse pregnancy outcomes, including maternal and fetal mortality, pregnancy loss, premature labor, and congenital anomalies. Mammalian gestation encounters an immunological paradox wherein the placenta balances the tolerance of an allogeneic fetus with protection against pathogens. Viruses cannot easily transmit from mother to fetus due to physical and immunological barriers at the maternal-fetal interface posing a restricted threat to the fetus and newborns. Despite this, the unknown strategies utilized by certain viruses could weaken the placental barrier to trigger severe maternal and fetal health issues especially through vertical transmission, which was not fully understood until now. In this review, we summarize diverse aspects of the major viral infections relevant to pregnancy, including the characteristics of pathogenesis, related maternal-fetal complications, and the underlying molecular and cellular mechanisms of vertical transmission. We highlight the fundamental signatures of complex placental defense mechanisms, which will prepare us to fight the next emerging and re-emerging infectious disease in the pregnancy population.

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Placental pathology in women with HIV

Cited by 12 publications

References 86 publications

Preterm Birth in Women With HIV: The Role of the Placenta

Preterm Birth in Women With HIV: The Role of the Placenta

Building Perinatal Pathology Research Capacity in Sub-Saharan Africa

Viral Infections During Pregnancy: The Big Challenge Threatening Maternal and Fetal Health

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