Fiore S, Newell ML, Trabattoni D, Savasi V, Tibaldi C, Lanzani C, Conserva V, Ferrazzi E, Clerici M; Conference on Retroviruses and Opportunistic Infections.
Abstr 10th Conf Retrovir Oppor Infect Feb 10 14 2003 Hynes Conv Cent Boston Mass USA Conf Retrovir Oppor Infect 10th 2003 Boston Mass. 2003 Feb 10-14; 10: abstract no. 354.
Univ Coll of London, UK
BACKGROUND: It has been shown that type 2 cytokines increase and type 1 cytokines decrease during normal pregnancy, and that weak type 2 cytokine production may adversely affect pregnancy outcome. Progression of HIV infection is also suggested to be associated with a type 1-to-type 2 shift, and antiretroviral therapy (ART) might reverse this immunological impairment. ART treated HIV-infected women are at increased risk of premature delivery. We investigated cytokine production in HIV-infected pregnant women and the association with ART and pregnancy outcome.METHODS: Mitogen- and gp160 (env)-stimulated IL-2 (Type 1), IL-10 (Type 2) and TNF alfa production was determined in 30 women 3 times during pregnancy by ELISA assays; mitogen- and env-stimulated intracellular cytokine concentration was studied in CD4+ or CD8+ cells by FACS; cytokine-specific mRNA was quantified by PCR; and mitogen- and env-stimulated CTL were analyzed using IFN-g Elispot assays. Results were related to anti-retroviral therapy, maternal CD4 count, RNA viral load and delivery details.RESULTS: Twenty-nine (29)/30 women were on ART before pregnancy (none received monotherapy). Twenty-four (24) women on combination ART stopped treatment before the 14th week of pregnancy. Eleven (11) women were treated with PI-including ART. One (1) woman with AIDS died at 27 weeks gestation (GA); 9 had pregnancy complications including: premature rupture of membranes (2), premature labour before 37 GA (2), severe IUG (2), intrauterine fetal death (1), and HELLP syndrome (2). All these 9 women were treated with PI-including ART. ENV-stimulated IL 2 production was significantly increased (p = 0.03) in the 9 women showing pregnancy complications. TNF alfa was reduced and HIV specific IL-10 was greatly diminished in these women, suggesting a degree of ART-associated functional immune reconstitution which was not seen in uncomplicated pregnancies.CONCLUSIONS: HIV disease and pregnancy may similarly impact on the immune environment, both stimulating a Type 2 response. Favourable immunomodulation induced by ART provides significant benefit in terms of HIV disease, but may be counterproductive in terms of successful pregnancy outcome.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Antiretroviral Therapy, Highly Active
- CD4 Lymphocyte Count
- CD8-Positive T-Lymphocytes
- Cytokines
- Drug Therapy, Combination
- Female
- Genes, env
- HIV Infections
- HIV Seropositivity
- Humans
- Interferon Type II
- Interleukin-10
- Interleukin-2
- Obstetric Labor, Premature
- Pregnancy
- Pregnancy Complications
- Pregnancy Outcome
- TNF protein, human
- Tumor Necrosis Factor-alpha
- Viral Load
- drug therapy
- genetics
- immunology
- therapy
Other ID:
UI: 102260943
From Meeting Abstracts