Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women
To examine the association between timing of antiretroviral treatment (ART) initiation in HIV-infected women and placental histopathology. A nested substudy in a larger cohort of HIV-infected women which examined the association between ART status and birth outcomes. Placentas (n = 130) were examine...
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| Veröffentlicht in: | AIDS (London) 2021-04, Vol.35 (5), p.717-726 |
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| creator | Ikumi, Nadia M. Malaba, Thokozile R. Pillay, Komala Cohen, Marta C. Madlala, Hlengiwe P. Matjila, Mushi Anumba, Dilly Myer, Landon Newell, Marie-Louise Gray, Clive M. |
| description | To examine the association between timing of antiretroviral treatment (ART) initiation in HIV-infected women and placental histopathology.
A nested substudy in a larger cohort of HIV-infected women which examined the association between ART status and birth outcomes.
Placentas (n = 130) were examined for histopathology from two ART groups: stable (n = 53), who initiated ART before conception and initiating (n = 77), who started ART during pregnancy [median (interquartile range) 15 weeks gestation (11-18)]. Using binomial regression we quantified associations between ART initiation timing with placental histopathology and pregnancy outcomes.
One-third of all placentas were less than 10th percentile weight-for-gestation and there was no significant difference between ART groups. Placental diameter, thickness, cord insertion position and foetal-placental weight ratio were also similar by group. However, placentas from the stable group showed increased maternal vascular malperfusion (MVM) (39.6 vs. 19.4%), and decreased weight (392 vs. 422 g, P = 0.09). MVM risk was twice as high [risk ratios 2.03 (95% confidence interval: 1.16-3.57); P = 0.01] in the stable group; the increased risk remaining significant when adjusting for maternal age [risk ratios 2.04 (95% confidence interval: 1.12-3.72); P = 0.02]. Furthermore, MVM was significantly associated with preterm delivery and low birth weight (P = 0.002 and |
| doi_str_mv | 10.1097/QAD.0000000000002824 |
| format | Article |
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A nested substudy in a larger cohort of HIV-infected women which examined the association between ART status and birth outcomes.
Placentas (n = 130) were examined for histopathology from two ART groups: stable (n = 53), who initiated ART before conception and initiating (n = 77), who started ART during pregnancy [median (interquartile range) 15 weeks gestation (11-18)]. Using binomial regression we quantified associations between ART initiation timing with placental histopathology and pregnancy outcomes.
One-third of all placentas were less than 10th percentile weight-for-gestation and there was no significant difference between ART groups. Placental diameter, thickness, cord insertion position and foetal-placental weight ratio were also similar by group. However, placentas from the stable group showed increased maternal vascular malperfusion (MVM) (39.6 vs. 19.4%), and decreased weight (392 vs. 422 g, P = 0.09). MVM risk was twice as high [risk ratios 2.03 (95% confidence interval: 1.16-3.57); P = 0.01] in the stable group; the increased risk remaining significant when adjusting for maternal age [risk ratios 2.04 (95% confidence interval: 1.12-3.72); P = 0.02]. Furthermore, MVM was significantly associated with preterm delivery and low birth weight (P = 0.002 and <0.0001, respectively).
Preconception initiation of ART was associated with an increased MVM risk, and may contribute to placental dysfunction. The association between MVM with preterm delivery and low birth weight suggests that a placenta-mediated mechanism likely links the putative association between long-term use of ART and adverse birth outcomes.</description><identifier>ISSN: 0269-9370</identifier><identifier>ISSN: 1473-5571</identifier><identifier>EISSN: 1473-5571</identifier><identifier>DOI: 10.1097/QAD.0000000000002824</identifier><identifier>PMID: 33724257</identifier><language>eng</language><publisher>England: Lippincott Williams & Wilkins</publisher><subject>Female ; Gestational Age ; HIV Infections - complications ; HIV Infections - drug therapy ; Humans ; Infant, Newborn ; Placenta ; Pregnancy ; Pregnancy Complications, Infectious - drug therapy ; Pregnancy Outcome</subject><ispartof>AIDS (London), 2021-04, Vol.35 (5), p.717-726</ispartof><rights>Lippincott Williams & Wilkins</rights><rights>Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4532-7485b5f553834480caccf3f4e61186fb6089a6f237e5ba1b1eb1ad5bc2148fb03</citedby><cites>FETCH-LOGICAL-c4532-7485b5f553834480caccf3f4e61186fb6089a6f237e5ba1b1eb1ad5bc2148fb03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33724257$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ikumi, Nadia M.</creatorcontrib><creatorcontrib>Malaba, Thokozile R.</creatorcontrib><creatorcontrib>Pillay, Komala</creatorcontrib><creatorcontrib>Cohen, Marta C.</creatorcontrib><creatorcontrib>Madlala, Hlengiwe P.</creatorcontrib><creatorcontrib>Matjila, Mushi</creatorcontrib><creatorcontrib>Anumba, Dilly</creatorcontrib><creatorcontrib>Myer, Landon</creatorcontrib><creatorcontrib>Newell, Marie-Louise</creatorcontrib><creatorcontrib>Gray, Clive M.</creatorcontrib><creatorcontrib>PIMS Study Group</creatorcontrib><title>Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women</title><title>AIDS (London)</title><addtitle>AIDS</addtitle><description>To examine the association between timing of antiretroviral treatment (ART) initiation in HIV-infected women and placental histopathology.
A nested substudy in a larger cohort of HIV-infected women which examined the association between ART status and birth outcomes.
Placentas (n = 130) were examined for histopathology from two ART groups: stable (n = 53), who initiated ART before conception and initiating (n = 77), who started ART during pregnancy [median (interquartile range) 15 weeks gestation (11-18)]. Using binomial regression we quantified associations between ART initiation timing with placental histopathology and pregnancy outcomes.
One-third of all placentas were less than 10th percentile weight-for-gestation and there was no significant difference between ART groups. Placental diameter, thickness, cord insertion position and foetal-placental weight ratio were also similar by group. However, placentas from the stable group showed increased maternal vascular malperfusion (MVM) (39.6 vs. 19.4%), and decreased weight (392 vs. 422 g, P = 0.09). MVM risk was twice as high [risk ratios 2.03 (95% confidence interval: 1.16-3.57); P = 0.01] in the stable group; the increased risk remaining significant when adjusting for maternal age [risk ratios 2.04 (95% confidence interval: 1.12-3.72); P = 0.02]. Furthermore, MVM was significantly associated with preterm delivery and low birth weight (P = 0.002 and <0.0001, respectively).
Preconception initiation of ART was associated with an increased MVM risk, and may contribute to placental dysfunction. The association between MVM with preterm delivery and low birth weight suggests that a placenta-mediated mechanism likely links the putative association between long-term use of ART and adverse birth outcomes.</description><subject>Female</subject><subject>Gestational Age</subject><subject>HIV Infections - complications</subject><subject>HIV Infections - drug therapy</subject><subject>Humans</subject><subject>Infant, Newborn</subject><subject>Placenta</subject><subject>Pregnancy</subject><subject>Pregnancy Complications, Infectious - drug therapy</subject><subject>Pregnancy Outcome</subject><issn>0269-9370</issn><issn>1473-5571</issn><issn>1473-5571</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQhi1ERZfCP0DIRy4p_ky8F6SqLbRSpapS4WrZ3vHGkMTBTna1F3473n7DXEaaed_HY70IfaDkmJJl8_nm5OyYvCimmHiFFlQ0vJKyoa_RgrB6WS15Qw7R25x_FpEkSr1Bh5w3TDDZLNCfs-A9JBimYDoc-tG4CUePTRkkmFLchFQWUwvJjDschlCEE6ywBR8T4Jjwak5hWOMxwXowg9vhOOCxM64wDR7N1MYurvdWfHH5oxpjLogN4G3sYXiHDrzpMrx_6Efo-9fz29OL6ur62-XpyVXlhOSsaoSSVnopueJCKOKMc557ATWlqva2Jmppas94A9IaailYalbSOkaF8pbwI_TlnjvOtofV_rbyLT2m0Ju009EE_e9mCK1ex41WNSeK0gL49ABI8fcMedJ9yA66zgwQ56yZJFRJyrgsUnEvdSnmnMA_PUOJ3kenS3T6_-iK7ePLE59Mj1k9c7exmyDlX928haRbMN3U3vEY4aRihFEiCCXV3Yj_BcBLp4Y</recordid><startdate>20210401</startdate><enddate>20210401</enddate><creator>Ikumi, Nadia M.</creator><creator>Malaba, Thokozile R.</creator><creator>Pillay, Komala</creator><creator>Cohen, Marta C.</creator><creator>Madlala, Hlengiwe P.</creator><creator>Matjila, Mushi</creator><creator>Anumba, Dilly</creator><creator>Myer, Landon</creator><creator>Newell, Marie-Louise</creator><creator>Gray, Clive M.</creator><general>Lippincott Williams & Wilkins</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20210401</creationdate><title>Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women</title><author>Ikumi, Nadia M. ; Malaba, Thokozile R. ; Pillay, Komala ; Cohen, Marta C. ; Madlala, Hlengiwe P. ; Matjila, Mushi ; Anumba, Dilly ; Myer, Landon ; Newell, Marie-Louise ; Gray, Clive M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4532-7485b5f553834480caccf3f4e61186fb6089a6f237e5ba1b1eb1ad5bc2148fb03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Female</topic><topic>Gestational Age</topic><topic>HIV Infections - complications</topic><topic>HIV Infections - drug therapy</topic><topic>Humans</topic><topic>Infant, Newborn</topic><topic>Placenta</topic><topic>Pregnancy</topic><topic>Pregnancy Complications, Infectious - drug therapy</topic><topic>Pregnancy Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ikumi, Nadia M.</creatorcontrib><creatorcontrib>Malaba, Thokozile R.</creatorcontrib><creatorcontrib>Pillay, Komala</creatorcontrib><creatorcontrib>Cohen, Marta C.</creatorcontrib><creatorcontrib>Madlala, Hlengiwe P.</creatorcontrib><creatorcontrib>Matjila, Mushi</creatorcontrib><creatorcontrib>Anumba, Dilly</creatorcontrib><creatorcontrib>Myer, Landon</creatorcontrib><creatorcontrib>Newell, Marie-Louise</creatorcontrib><creatorcontrib>Gray, Clive M.</creatorcontrib><creatorcontrib>PIMS Study Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>AIDS (London)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ikumi, Nadia M.</au><au>Malaba, Thokozile R.</au><au>Pillay, Komala</au><au>Cohen, Marta C.</au><au>Madlala, Hlengiwe P.</au><au>Matjila, Mushi</au><au>Anumba, Dilly</au><au>Myer, Landon</au><au>Newell, Marie-Louise</au><au>Gray, Clive M.</au><aucorp>PIMS Study Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women</atitle><jtitle>AIDS (London)</jtitle><addtitle>AIDS</addtitle><date>2021-04-01</date><risdate>2021</risdate><volume>35</volume><issue>5</issue><spage>717</spage><epage>726</epage><pages>717-726</pages><issn>0269-9370</issn><issn>1473-5571</issn><eissn>1473-5571</eissn><abstract>To examine the association between timing of antiretroviral treatment (ART) initiation in HIV-infected women and placental histopathology.
A nested substudy in a larger cohort of HIV-infected women which examined the association between ART status and birth outcomes.
Placentas (n = 130) were examined for histopathology from two ART groups: stable (n = 53), who initiated ART before conception and initiating (n = 77), who started ART during pregnancy [median (interquartile range) 15 weeks gestation (11-18)]. Using binomial regression we quantified associations between ART initiation timing with placental histopathology and pregnancy outcomes.
One-third of all placentas were less than 10th percentile weight-for-gestation and there was no significant difference between ART groups. Placental diameter, thickness, cord insertion position and foetal-placental weight ratio were also similar by group. However, placentas from the stable group showed increased maternal vascular malperfusion (MVM) (39.6 vs. 19.4%), and decreased weight (392 vs. 422 g, P = 0.09). MVM risk was twice as high [risk ratios 2.03 (95% confidence interval: 1.16-3.57); P = 0.01] in the stable group; the increased risk remaining significant when adjusting for maternal age [risk ratios 2.04 (95% confidence interval: 1.12-3.72); P = 0.02]. Furthermore, MVM was significantly associated with preterm delivery and low birth weight (P = 0.002 and <0.0001, respectively).
Preconception initiation of ART was associated with an increased MVM risk, and may contribute to placental dysfunction. The association between MVM with preterm delivery and low birth weight suggests that a placenta-mediated mechanism likely links the putative association between long-term use of ART and adverse birth outcomes.</abstract><cop>England</cop><pub>Lippincott Williams & Wilkins</pub><pmid>33724257</pmid><doi>10.1097/QAD.0000000000002824</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | AIDS (London), 2021-04, Vol.35 (5), p.717-726 |
| issn | 0269-9370 1473-5571 1473-5571 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8630811 |
| source | MEDLINE; EZB-FREE-00999 freely available EZB journals |
| subjects | Female Gestational Age HIV Infections - complications HIV Infections - drug therapy Humans Infant, Newborn Placenta Pregnancy Pregnancy Complications, Infectious - drug therapy Pregnancy Outcome |
| title | Differential impact of antiretroviral therapy initiated before or during pregnancy on placenta pathology in HIV-positive women |
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