Abstract
BackgroundMitochondrial toxicity related to maternal combined antiretroviral treatment (cART) may have an impact on the heart of HIV-exposed uninfected (HEU) fetuses. Our objective was to evaluate fetal cardiovascular and mitochondrial biomarkers in HIV pregnancies.MethodsProspective cohort including 47 HIV-infected and 47 non HIV-infected pregnancies. Fetal echocardiography was performed at 26–32 weeks of pregnancy. Umbilical cord blood and placental tissue were collected to study mitochondrial DNA content (mtDNA) (ratio 12SrRNA/RNAseP) and mitochondrial function (cytochrome c oxidase, COX, enzymatic activity) normalized by mitochondrial content (citrate synthase, CS).ResultsHEU fetuses showed hypertrophic hearts (left myocardial wall thickness: HIV mean 3.21 mm (SD 0.81) vs. non-HIV 2.72 (0.42), p = 0.012), with signs of systolic and diastolic dysfunction (isovolumic relaxation time: HIV 52.2 ms (8.85) vs. non-HIV 42.5 ms (7.30); p<0.001). Cord blood mitochondrial content was significantly increased in HIV-exposed fetuses (CS activity: HIV 82.9 nmol/min.mg of protein (SD 40.5) vs. non-HIV 56.7 nmol/min.mg of protein (28.4); p = 0.007), with no differences in mtDNA content and COX activity. Both myocardial and mitochondrial mass parameters were significantly associated with zidovudine exposure.ConclusionsHEU fetuses showed signs of increased myocardial and mitochondrial mass associated with maternal zidovudine treatment, suggesting a fetal adaptive response to cART toxicity.
Highlights
Perinatal transmission of Human Immunodeficiency Virus (HIV) is mainly prevented by combined antiretroviral treatment during pregnancy [1]
Cord blood mitochondrial content was significantly increased in HIV-exposed fetuses (CS activity: HIV 82.9 nmol/min.mg of protein (SD 40.5) vs. non-HIV 56.7 nmol/min. mg of protein (28.4); p = 0.007), with no differences in mitochondrial DNA (mtDNA) content and c oxidase (COX) activity
Both myocardial and mitochondrial mass parameters were significantly associated with zidovudine exposure
Summary
Perinatal transmission of Human Immunodeficiency Virus (HIV) is mainly prevented by combined antiretroviral treatment (cART) during pregnancy [1]. HEU children are mainly considered a healthy population, recent studies have raised concerns regarding their cardiovascular health. A recent study by our group suggested that fetal cardiac remodeling observed in HIV-infected pregnancies was associated with maternal use of zidovudine [11]. Mitochondrial toxicity related to HIV or cART use during pregnancy may be a potential pathophysiological pathway responsible for these cardiovascular changes. Mitochondrial toxicity related to maternal combined antiretroviral treatment (cART) may have an impact on the heart of HIV-exposed uninfected (HEU) fetuses. Our objective was to evaluate fetal cardiovascular and mitochondrial biomarkers in HIV pregnancies
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