Leukocyte counts and lymphocyte subsets in relation to pregnancy and HIV infection in Malawian women.

Wilson L. Mandala,Malcolm E. Molyneux,Calman A. MacLennan,Esther N. Gondwe,Jenny M. MacLennan

doi:10.1111/aji.12678

Abstract

ProblemWe investigated leukocyte and lymphocyte subsets in HIV‐infected or HIV‐uninfected, pregnant or non‐pregnant Malawian women to explore whether HIV infection and pregnancy may act synergistically to impair cellular immunity.Method of studyWe recruited 54 pregnant and 48 non‐pregnant HIV‐uninfected women and 24 pregnant and 20 non‐pregnant HIV‐infected Malawian women. We compared peripheral blood leukocyte and lymphocyte subsets between women in the four groups.ResultsParturient HIV‐infected and HIV‐uninfected women had more neutrophils (each P<.0001), but fewer lymphocytes (P<.0001; P=.0014) than non‐pregnant women. Both groups had fewer total T cells (P<.0001; P=.002) and CD8+ T cells (P<.0001; P=.014) than non‐pregnant women. HIV‐uninfected parturient women had fewer CD4+ and γδ T cells, B and NK cells (each P<.0001) than non‐pregnant women. Lymphocyte subset percentages were not affected by pregnancy.ConclusionMalawian women at parturition have an increased total white cell count due to neutrophilia and an HIV‐unrelated pan‐lymphopenia.

Highlights

In the Global Burden of Disease 2010 study, 254 700 deaths were attributed to maternal conditions, accounting for 7.3% of global deaths in women aged 15 to 49 years
We explored the effect of pregnancy at parturition on leukocyte and lymphocyte subsets by comparing results between parturient and non-pregnant HIV-uninfected Malawian women
We found that the effect of pregnancy in HIV-infected women was similar to that observed in HIV-uninfected women effectively ruling out a possible synergistic effect of HIV infection and pregnancy as a possible factor for the increased proportion of death from sepsis in HIV-infected pregnant women

Summary

| INTRODUCTION

In the Global Burden of Disease 2010 study, 254 700 deaths were attributed to maternal conditions, accounting for 7.3% of global deaths in women aged 15 to 49 years. | 2 of 7 the HIV/AIDS pandemic since the early 1990s, this decline slowed to 1.4% per year for the period 1990-2008.2 From 1990 to 2000, the maternal mortality ratio (MMR) increased in many countries in sub- Saharan Africa with large HIV burdens; in Malawi, the reported MMR doubled in that decade from 606 to 1397 per 100 000 live births.[3] With the implementation of antiretroviral programmes, this trend has been reversed, and in 2011, the MMR in Malawi had fallen to 422.3 despite availability of ART, 20.5% (56 100) of maternal deaths worldwide in 2010 were HIV-related.[1]. We hypothesized that HIV infection and pregnancy may act synergistically to impair cellular immunity, reducing CD4 counts and potentially increasing susceptibility to infection To explore this possibility among African women, we performed a prospective cross-sectional study of HIV-infected and HIV-uninfected pregnant and non-pregnant Malawians attending a health centre in Blantyre and compared leukocyte and lymphocyte subsets at parturition with those in non-pregnant women

| MATERIALS AND METHODS

| Ethical approval

Findings

| DISCUSSION

| CONCLUSION