HIV-seronegative Pregnant Women Research Articles

Pregnancy-associated Plasma Protein-A, Progesterone, and Oestriol Levels and Some Birth Outcomes in HIV-seropositive Pregnant Women at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Abstract Background: Pregnancy is associated with biochemical alterations and may be compounded by human immunodeficiency virus (HIV) infection potentially affecting pregnancy outcome such as birth weight, Apgar score, and foetal viability (stillbirth or intrauterine foetal death [IUFD]). Aims: This prospective case–control study evaluated some biochemical parameters and their possible effects on pregnancy outcome in HIV-seropositive subjects. Patients, Materials and Methods: The study involved 136 HIV seropositives on highly active antiretroviral therapy and 137 HIV-seronegative pregnant women, recruited from the Antenatal Clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Pregnancy-associated plasma protein-A (PAPP-A), oestriol (E3), and progesterone were analysed using an enzyme-linked immunosorbent assay method, and the delivery outcomes were reported. Results: Progesterone was significantly higher (P = 0.002) in HIV-seropositive individuals (59.3 ± 17.84 ng/mL) compared to controls (54.89 ± 8.24 ng/mL). There were no significant differences in the levels of E3 and PAPP-A between the two groups. In HIV seronegatives, there were no significant changes in measured biochemical parameters between trimesters (P > 0.05). There were no significant differences in measured biochemical parameters between subjects with IUFD and subjects with live births (P > 0.05) for both the test and control groups. Subjects with significantly lower PAPP-A in HIV seropositives had babies with higher Apgar score. The incidence of IUFD was 7.31% among HIV seropositives and 7.47% among HIV seronegatives. Conclusion: HIV infection affects some biochemical indices such as progesterone and PAPP-A but does not adversely affect pregnancy outcomes in HIV seropositives under antiretroviral therapy.

Longitudinal Variations of M. tuberculosis-Induced IFN-γ Responses in HIV-Negative Pregnant Women Exposed to Tuberculosis.

IntroductionPregnancy triggers an alteration of the immune functions and increases the risk of developing the active tuberculosis (TB) symptoms in exposed women. The effect of pregnancy on the Mycobacterium tuberculosis-specific immune responses used for most of the TB immunodiagnostic assays is not well documented. Here we investigated the changes in the M. tuberculosis-specific IFN-γ production in age-matched pregnant and non-pregnant women according to their TB exposition status.MethodsWe conducted a prospective cohort study on HIV-seronegative pregnant and non-pregnant women with compatible pulmonary TB symptoms addressed to TB healthcare facilities in Antananarivo, Madagascar. Active pulmonary TB was bacteriologically assessed with culture from sputum samples. Clinical data and blood samples were collected at inclusion and after 6 months of follow-up for each individual included. Whole blood samples were stimulated with QuantiFERON TB-Gold Plus (QFT-P) assay antigens. Plasma IFN-γ concentrations were then assessed by ELISA.ResultsA total of 284 women were investigated for the study including 209 pregnant women without confirmed TB (pNTB), 24 pregnant women with bacteriologically confirmed active TB (pATB), 16 non-pregnant women with active TB (ATB), and 35 non-pregnant healthy donors (HC). At inclusion, IFN-γ responses are lower in the pregnant women compared to their age-matched non-pregnant counterparts and independently of their TB status. Among the pregnant women, higher concentrations of M. tuberculosis-specific IFN-γ were observed in those exposed to TB, but with a lower magnitude in the active TB compared to the latently infected pregnant women (p < 0.05 with TB1 and p < 0.01 with TB2). After 6 months of follow-up, the M. tuberculosis-specific IFN-γ responses return to their baseline concentrations except for the pregnant women treated for TB for which none of the QFT-P positive reversed to negative (0%, 0/10) at the end of their TB treatment.ConclusionThese results support the concept of specific immune priorities characterized by a concomitant reduction in inflammatory immunity during pregnancy and corroborate the important role of activating the M. tuberculosis-specific immune responses to control the infection when the pregnant women are exposed to the pathogen.

Establishment of CD4 and CD8 Lymphocyte subsets in a healthy HIV and Toxoplasma seronegative pregnant women in Libya

Most of the diagnostic laboratories in Libya often depend on western textbooks for CD4+- and CD8+ T-lymphocyte reference values. In this paper, we established reference ranges for the Libyan Toxoplasma, HIV, HBV, and HCV seronegative healthy pregnant women in all trimesters of pregnancy, and compared them with a control group of non-pregnant women. Wholeblood samples were collected to provide normal ranges for CD4+ and CD8+ Lymphocyte subsets expressed as mean ± standard division. A total of 110 Libyan women who came from Tripoli and Zwara districts were investigated; 70 pregnant women (aged 27.8 ± 2.99, range 18-40 years old) and 40 non-pregnant women (aged 22.7±3.01, range 18-40 years old) were included as controls. All cases/controls were seronegative for toxoplasmosis, HIV, HBV and HCV. The CD4+ cell counts were 685±256 cell/#l at the first trimester (T1), 740±202 at T2, and 923±203 cell/#l at T3. While the CD8+ cell counts were 451±171 cell/#l at T1, 541±168 at T2, and 753±190 cell/#l at T3. The CD4:CD8 ratios were 1.5±0.64 at T1, 1.4±0.51 at T2, and 1.2±0.36 at T3. Moreover, the mean absolute CD4+ and CD8+ counts for the control group were 1001±232 cell/#l and 717±159 cell/#l respectively. Absolute counts of CD4+ and CD8+ cells in pregnant women were significantly lower as compared to controls (P&lt;0.05). Statistically significant decrease in the CD4+ and CD8+ cell counts was reported during T1 (P&lt;0.05). These values increased significantly during the T2, and was comparable to the controls during T3 (P&gt;0.05). The absolute CD4+ and CD8+ cell counts decreased with age for both groups. Geographical variation was reported for the cell counts between Tripoli and Zwara district at T3. We established reference ranges of CD4+ and CD8+ T-lymphocytes for the Libyan healthy pregnant women and discussed their use as prognostic markers. Further cohorts with greater sample size may be required to define the stage of the disease in relation to the normal CD4+ and CD8+ T lymphocyte count subsets in the Libyan population.

Prevalence of Malaria with Anaemia and HIV Status in Women of Reproductive Age in Onitsha, Nigeria

The major health problems affecting pregnant women in sub-Saharan African are anaemia, malaria and HIV. A case-control study aimed at determining the prevalence of malaria, anaemia and HIV status among women of reproductive age between 20-49 years attending General Hospital, Onitsha was conducted. Blood samples of three hundred and sixty-two apparently healthy gravid women attending antenatal and 181 non-gravid apparently healthy women in Onitsha were recruited using random sampling method. A structured questionnaire was used for data collection. Haemoglobin was estimated using automated method, Malaria, diagnosed microscopically using gold standard staining method and HIV screened using qualitative immunochromatographic method, confirmed molecularly. Statistical analysis was done using SPSS version 21. Results revealed that out of the 362 pregnant test groups,125 (34.5%) had malaria parasite (mp) in their blood and were anaemic 53(37.6%) though fewer in control groups ;23,14 (12.7%; 16.1%) (p = 0.195; p =0.055). Out of 347 HIV sero-negative pregnant women, 110 (31.7%) tested HIV positive when confirmed by PCR molecular method while only 1(0.6%) sero-negative controls were confirmed positive with molecular method with statistical significance observed in the test and control groups (p = 0.000; p = 0.000). However, as pregnancy affects HIV serology testing, it is necessary to use molecular method to increase its sensitivity and more enlightment programmes on the importance of balanced diet, compliance to Malaria control and routine gynecological drugs intake in pregnant women.

Effect of Antiretroviral Drugs on Liver Biochemical Parameters of HIV/AIDS-Infected Pregnant Women in Enugu Metropolis, Nigeria: a Cross-Sectional Study

Background and Objective: Certain liver diseases are uniquely associated with pregnancy, whereas others are unrelated. Highly Active Antiretroviral Therapy (HAART)-associated hepatic toxicity is of increasing concern in the management of patients with HIV/AIDS. There is no available data on whether pregnancy is associated with an increased risk of liver damage and chronic liver damage in HIV-positive women on HAART. We evaluated the effects of antiretroviral drugs on the liver biochemical parameters in HIV-infected pregnant women. Methods: Using cross-sectional survey design, 171 women were exclusively screened for hepatitis B and hepatitis C infections; grouped as 50 HIV sero-negative pregnant women, 20 newly diagnosed HIV-infected pregnant women (treatment-naïve), 51 HIV-infected pregnant women already on HAART, 12 non-pregnant infected females (treatmentnaive) and 38 non-pregnant HIV-infected women on HAART. Liver biomarkers were determined using standard methods. Student’s t-test and one-way analysis of variance (ANOVA) followed by Tukey’s Post-HOC multiple comparison tests were used to analyse the results. Results: The Aspatate Transaminase (AST), Alanine Transaminase (ALT), Alkaline Phosphatase (ALP) and Total Bilirubin (TB) levels in HIV-infected pregnant women on HAART were elevated. The AST (29.40±4.35 U/L) of naïve HIV-infected pregnant women was significantly low (p&lt;0.05) compared to non-pregnant naive HIV-infected women with AST (53.36±5.92 U/L). Also, the ALP (272.5±22.79 U/L) and TP (80.9±4.40 g/L) of naïve HIV-infected pregnant women were highly significant (p&lt;0.05) compared to non-pregnant naive HIV-infected women with ALP and TP levels of (200.30±12.74 U/L) and (63.70±6.50) g/L respectively. On the basis of trimester, HIV-positive pregnant women on HAART had significantly higher levels of liver markers when compared with that of HIVsero-negative pregnant women. Interpretation and Conclusion: Pregnancy is associated with an increased risk of liver damage and chronic liver damage in HIV-positive women on HAART.

Serological survey and risk factors associated with Toxoplasma gondii infection among HIV-infected pregnant women attending Abuja Tertiary Hospital, Nigeria.

Toxoplasmosis in pregnancy could induce miscarriage, congenital anomalies in foetuses and encephalitis in HIV-infected people. Hence, there is a need to determine the prevalence of toxoplasmosis in HIV-infected pregnant women to inform clinicians about the significance of maternal toxoplasmosis in antenatal care. This study aimed to determine the seroprevalence of Toxoplasma gondii infection, associated CD4+ T-cell profile and sociodemographic risk factors among pregnant women with or without HIV infection attending the University of Abuja Teaching Hospital, Abuja, Nigeria. This hospital-based cross-sectional study involved blood samples collected from 160 HIV-infected and 160 HIV-seronegative pregnant women. These samples were analysed for anti-T. gondii (IgG and IgM) and CD4+ T-cell count using ELISA and flow cytometry, respectively. Sociodemographic variables of participants were collected using structured questionnaires. The overall seroprevalence of anti-T. gondii IgG and IgM was 28.8% and 3.8%, respectively. The seroprevalence of anti-T. gondii IgG and IgM was 29.4% and 4.4%, respectively, among HIV-seropositive pregnant women and 28.1% and 3.1%, respectively, among HIV-seronegative women. There was no significant association between the seroprevalence of anti-T. gondii-IgG and anti-T. gondii-IgM with age, gestational age, education level, parity or place of residence of HIV-infected pregnant women (P > 0.05). However, there was significant association between the seroprevalence of anti-T. gondii-IgG (P = 0.03) and anti-T. gondii-IgM (P = 0.01) with education level. CD4+ T-cell count varied significantly between HIV-infected and HIV-uninfected pregnant women (P = 0.035). In this study, the seroprevalence of anti-T. gondii IgG and IgM did not differ in HIV-seropositive or HIV-seronegative pregnant women. However, women with primary T. gondii and HIV coinfection had lower CD4+ T-cell count than those with toxoplasmosis monoinfection.

Parity and its effect on the CD4+ count of hiv-seronegative pregnant women attending Adeoyo hospital, Ibadan, Nigeria

Parity and its effect on the CD4+ count of hiv-seronegative pregnant women attending Adeoyo hospital, Ibadan, Nigeria

Antibiotic Drug Resistance in HIV Seropositive Pregnant Women

Background: Vaginal infections are often associated with a significant risk of morbidity especially in pregnant women. These infections if left untreated often result in a long-term sequelae and poses a higher adverse pregnancy outcome especially in immunocompromised women. While HIV infection has been reported to be a high risk of pathogenic bacterial colonization, the misuse of antibiotics is high among women in developing countries. Methodology and results: A high vaginal swab was collected from the posterior fornix from each pregnant women by the attending physician using sterile bivalve speculum and a cotton- tipped applicator. Each sample was cultured and identified using standard bacterlogical methods. Selected pathogens were thereafter tested for their sensitivity to 23 commonly prescribed antibiotics using the Kirby-Bauer method. Altogether, 1,156 bacterial isolates were cultured from high vaginal swabs of both 114 HIV seropositive and 126 HIV seronegative pregnant women, averaging 4.81 bacterial per subject each for both cohorts. S. aureus was seen as the single predominant isolate recovered from both groups. In addition, of the 22 S. aureus recovered from HIV infected women, 10 isolates were Methicillin resistant S. aureus (MRSA) and 12 Methicillin sensitive S aureus (MSSA), while, of the 25 S. aureus recovered from HIV seronegative women, 13 isolates were Methicillin resistant S. aureus (MRSA) and 12 Methicillin sensitive S aureus (MSSA). Other gram negative pathogens associated with lower genital infections were also studied. Conclusion: The incidence of multiple antibiotic resistance was high among isolates recovered from both cohorts, which is probably due to uncontrollable ease of access to these antibiotics in the environment where antibiotics restriction/policy is lacking. There is an urgent need for continuous monitoring, health education, drug abuse awareness and implementation of interventions to restrict antibiotic abuse especially among immunocompromised individuals in the study environment.

Establishment of Immunohematological Reference Values among HIV Sero-negative Pregnant Women at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia.

Normal pregnancy is characterized by profound changes in almost every organ and system. Immunohematological parameters are important in clinical practice for the assessment of health and disease. Therefore, this study was aimed to establish immunohematological reference range among HIV sero-negative pregnant women. A cross-sectional study was conducted among HIV sero-negative pregnant women at St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, from 20/1-30/6/ 2016. Whole blood was collected and immunological and hematological parameters were measured following the standard procedure. Data were entered in to Epi Info version 3.5, checked for completeness and exported to SPSS version 20 software for analysis. The mean ± SD and 95% Confidence Interval (95% CI) values were calculated for different immunohematological parameters. A total of 400 women with mean age ±SD (27.3 ±4.7) ranging from 18-40 years were enrolled. The mean ± SD reference value of white blood cells count with 95% CI was 8.3 ±2.3 (8.1-8.6) ×109 cells/L and for CD4+, CD8+, and CD4 to CD8 ratio cells absolute count with 95% CI were 906 ±404 (867-946), 698± 378 (662-736) cell/µl, and 1.5±0.9 (1.4-1.6), respectively.The mean ± SD reference values for red blood cells count with 95% CI was 4.5±0.5(4.4-4.5) 1012/L, for hemoglobin 14±7.2(13.3-14.7) gm/dl, and for hematocrite was 39.5± 4(39-39.9). These values were lower than the one from developed countries but not lower than the one from other African studies. It suggests the need for further large study.

Immunological and hematological reference intervals among HIV-seronegative pregnant women in northwest Ethiopia.

BackgroundPregnancy is a state characterized by profound physiological hematological changes. However, hematological reference intervals being used in clinical practice in Ethiopia are derived from nonlocal general populations, despite the significant variations reported previously. The aim of this study was to determine the immunological and hematological reference intervals in healthy pregnancy among HIV-seronegative pregnant women in northwest Ethiopia.Materials and methodsA total of 200 healthy, HIV-seronegative pregnant women were enrolled from February 2015 to June 2015 in a cross-sectional study setting at Gondar University Hospital. Sociodemographic and obstetric data were collected using a structured questionnaire. Blood samples collected from each participant were used to define the immunological and hematological parameters. The mean, median, and 95% interval values were calculated for the immunological and hematological parameters. P-value <0.05 was considered statistically significant for all variables.ResultsThis study found that there were changes in CD4+ T-cell count, platelet count, and hematocrit (HCT) values as pregnancy advances. The calculated combined reference intervals for the absolute CD4+ T-cell count and platelet count were 712.47–760.67 and 221.25–240.14, respectively. A progressive decline in the platelet count was observed as pregnancy advanced, with 95% intervals of 224.53–253.21, 209.50–237.38, and 213.70–247.86 in the first, second, and third trimesters, respectively (P=0.27). There was a statistically significant increase in mean (±standard deviation [SD]) HCT with gestational age, being 39.18±6.70, 41.96±3.70, and 40.53±3.77 in the first, second, and third trimesters, respectively (P=0.03). The overall 95% interval for hemoglobin (HB) concentration was 12.99–13.36 g/dL, HCT 40.19%–41.49%, mean corpuscular volume (MCV) 93.33–94.63 fL, and mean corpuscular hemoglobin (MCH) 28.88–34.81 pg. Compared with the reference ranges derived from other studies, we found considerable variations in CD4+T-cell count, HB, HCT, and MCV values.ConclusionThe findings of this study highlight the differences in immunohematological profile among pregnant women and nonpregnant women from Ethiopia and other countries, in addition to suggesting the need for such establishment of local reference values for different populations.

Identification of Virulence Factors Produced by Candida Isolates from HIV Seropositive and HIV Seronegative Pregnant Women

Identification of Virulence Factors Produced by Candida Isolates from HIV Seropositive and HIV Seronegative Pregnant Women

Candida colonization of the vagina of HIV-seropositive pregnant women and their seronegative counterparts at selected health-care centers in Akure, Ondo State, Nigeria

Background: Candida colonization of the vagina is a risk factor in pregnancy. Candida isolates have been implicated in adverse pregnancy outcomes. The study determined the incidence of Candida species recovered from the vagina of HIV-seropositive and HIV-seronegative pregnant women that attended antenatal clinics in Akure, Ondo State between November 2014 and December 2015. Materials and Methods: Two hundred and forty pregnant women aged 19–43 participated in the study, which included 114 HIV-seropositive subjects with mean age 31.81 years and 126 HIV-seronegative subjects with mean age 29.05 years as controls. High vaginal swab was collected from each subject using sterile cotton-tipped applicator, streaked onto Mycological Agar - supplemented with streptomycin. Each sample was incubated 24 h for yeast and 72–120 h for the growth of molds. Yeast colonies that grew on Mycological Agar were picked and studied. Thereafter, colonies resembling Candida were identified using sugar assimilation and fermentation. Candida isolates were further speciated using Candida Ident Agar, modified. Antifungal resistance profile was identified with azoles, polyenes, echinocandins, flucytosine, and griseofulvin drugs. Antifungal resistant assay was determined by disc and agar well diffusion. Results: Altogether, 157 Candida isolates were recovered from HIV-seropositive and HIV-seronegative subjects. Candida albicans constituted 46.5%, Candida dubliniensis and Candida glabrata 15.3% each, Candida krusei 12.1%, Candida spp. 5.7%, and Candida tropicalis and Candida pseudotropicalis 2.5% each. Antifungal resistance was widespread with azoles, polyenes, echinocandins, flucytosine, and griseofulvin. Conclusion: C. albicans was the predominant isolate recovered (17.2% HIV-seropositive and 29.3% HIV-seronegative subjects). Widespread antifungal resistance seems high and suggests possible abuse of these drugs.

Coinfections of Human Immunodeficiency Virus and Sexually Transmitted Infections among HIV Seropositive Pregnant Women at Healthcare Centres in Akure, Southwestern Nigeria

Background: Sexually transmitted infections (STIs) represent significant risk factors for HIV transmission and adverse fetal complications in pregnancy. We tested 240 pregnant women for their HIV serostatus and for the effects of HIV-STI coinfections on CD4+ cell counts and on HIV plasma viral load. The study was conducted at four antenatal clinics in Akure, Ondo State of Nigeria between November 2014 and December 2015. Methods: The HIV-1/2 strip was used for preliminary determination of HIV serostatus and this was followed by a confirmatory Abbott enzyme-linked immunosorbent assay (ELISA) procedure. CD4+ T-cell counts were done by cytometric analysis while viral load was determined by COBAS® AmpliPrep TaqMan HIV-1 procedure. Liver enzymes were determined by an automated chemistry analyzer. Detection of hepatitis B virus (HBV), hepatitis C virus (HCV), human papilloma virus-6 (HPV-6) and herpes simplex virus type-2 (HSV-2) were determined by ELISA. The syphilis VDRL test was done by the rapid plasma reagin procedure, while Trichomonas vaginalis infection was demonstrated by the wet mount procedure. Infections with Chlamydia trachomatis and Neisseria gonorrhoeae were determined respectively by ELISA and by culture on proteose peptone agar supplemented with 5% serum. Results: The results show prevalence of STIs in 33.3% of the 240 study participants; 77.5% for HIV seropositive and 22.5% for seronegative subjects. Trichomonas vaginalis constituted the highest isolate Coinfections in 50% of HIV seropositive subjects and 22.2% for seronegative controls. HIV-HBV coinfection occurred among 7 individuals while HIVHBV-TV coinfection occurred in 4 individuals. The results also showed elevated titers of alanine aminotransferase (ALT), creatinine and total bilirubin liver enzymes in both HIV-HBV coinfection and HBV monoinfection. HIV viral loads were twice as high in HIV-HBV coinfection relative to HBV mono- infection. Conclusion: The prevalence of STIs was significantly high at 54.4% among HIV seropositive pregnant women as compared to 14.3% for HIV seronegative pregnant women. T. vaginalis was the highest isolate at 50% in HIV seropositive subjects and may therefore be a driving factor for HIV transmission and susceptibility as very few T. vaginalis infections were recorded in control subjects.

Comparison of CD4 Cell Counts in Pregnant HIV-Seropositive and HIV-Seronegative Nigerian Women

Objective: To evaluate the CD4 cell count of human immunodeficiency virus (HIV)-positive pregnant ethnic Nigerian women and compare it with that of HIV-negative pregnant ethnic Nigerian women and to determine the relationship between CD4 cell count and the packed red blood cell volume (PCV) of HIV-seropositive and HIV-seronegative pregnant women. Materials/Methods: The study population included 130 ethnic Nigerian women between the ages of 17 and 40 years who came to the Antenatal and Prevention of Mother-to-Child Transmission (PMTCT) units of Jos University Teaching Hospital, in Jos, Nigeria. Relevant information such as age, occupation, tribal affiliation, gestational age, and prescribed drugs currently taken were obtained using a structured questionnaire. A selective technique was used to enroll pregnant women who tested positive for HIV infection and negative for malaria parasitemia, syphilis, and hepatitis B virus, along with healthy pregnant women with no history of these diseases. CD4 cell counts were determined using a Cyflow machine and packed red blood cell volume (PCV) obtained using a microhematocrit centrifuge. The Student t-distribution t-test was used to analyze data. Results: The highest prevalence of HIV infection was found in the group aged 26 to 30 years; the lowest prevalence was found in the group aged 36 to 40 years. The mean (SD) CD4 cell counts of HIVseropositive and seronegative women were 323.7 (170.7) and 578.3 (167.4), respectively (P < .001). Comparison of the CD4 cell count of HIV-positive and HIV-negative pregnant women with the PCV values from specimens from those women demonstrated a correlation coefficient r of 0.37 (P < .001) for the former group and an r of 0.37 (P < .82) for the latter. In HIV-seropositive and HIV-seronegative pregnant women with gestational age of less than 13 weeks, the mean (SD) CD4 cell counts were 610.X (170.3) (P < .001) and 302.0 (49.0) (P < .001) for the former and latter groups, respectively. The mean CD4 cell counts of the HIV-positive and HIV-negative pregnant women enrolled in our study with gestational age of 13 to 25 weeks and 26 to 38 weeks were 596 (146) (P < .001), 304 (170) (P < .001), 534 (189) (P < .001), and 254 (191) (P <.003), respectively. Conclusions: This study suggests that pregnancy may partially deplete CD4 cells because a significant difference was observed in mean (SD) CD4 cell count in HIV-seropositive and HIV-seronegative pregnant women at various gestational ages. Chronological age did not affect the mean CD4 cell count if there was no accompanying disease condition. We also conclude that PCV in HIV-seropositive pregnant women was directly proportional to their CD4 cell counts.

Histomorphometric and immunohistochemical analysis of infectious agents, T-cell subpopulations and inflammatory adhesion molecules in placentas from HIV-seropositive pregnant women.

BackgroundThe aim of this study was to compare histomorphometric changes and the results of immunohistochemical tests for VCAM, ICAM-1, CD4 and CD8 in normal placentas from HIV-seropositive pregnant women.MethodsSamples of normal placentas were divided into 2 groups: healthy HIV-seronegative pregnant women (control group = C = 60) and HIV-seropositive women (experimental group = E = 57). Conventional histological sections were submitted to morphometric analysis and evaluated in terms of the immunohistochemical expression of ICAM-1, VCAM, CD4 and CD8.ResultsThe villi in group E were smaller than those in group C. The median for the CD8+ T cell count was higher in group E than in group C (p = 0.03). Immunohistochemical expression of ICAM-1 was observed in 57% of the cases in group E, compared with 21% of those in group C (p = 0.001). There was no difference in VCAM expression or CD4+ cell counts between groups and no correlation between the data for antiretroviral therapy and morphometric or immunohistochemical data.ConclusionsThe morphometric data showed that placentas of HIV-seropositive pregnant women tend to have smaller villi than those of seronegative women. In addition, immunohistochemical testing for infectious agents helped to identify cases that were positive for microorganisms (6/112) that routine pathological examination had failed to detect. The anti-p24 antibody had a limited ability to detect HIV viral protein in this study (2/57). Correlation of immunohistochemical expression of CD8+ T cells and ICAM-1 with the presence of HIV in the placenta revealed that those expressions can act as biomarkers of inflammatory changes. There was no correlation between the data for antiretroviral therapy and morphometric or immunohistochemical data.

Reference Values of CD4-Lymphocyte Counts in HIV Seronegative Pregnant Women in Buea, Cameroon

Pregnancy is a physiologically immunocompromised state, during which alterations in T-lymphocyte subsets may occur. Reference values for CD4 counts in pregnancy have not been established particularly in sub-Saharan populations. This study aimed at describing expected (‘normal’) values of CD4 counts in healthy HIV-negative pregnant women so these could serve as reference for assessing the progress of HIV disease in HIV-infected pregnant women. The study was conducted in antenatal clinics in the Buea Health District, Cameroon. All eligible women were interviewed using a standardized questionnaire. Whole blood samples collected were tested for HIV using Determine 1/2 and SD Bioline HIV-1/2 3.0 rapid tests. The CD4+ absolute counts were assessed using the Partec Cyflow Counter and the CD4 easy count kit. A total of 279 women were analysed. Their ages ranged from 15 to 47 years. A vast majority (95%) of participants were in the second or third trimester of gestation. Slightly less than half (43%) were primiparous. The CD4 cell count ranged from 321 to 1808 cells/μl . This distribution was approximately normal with a mean of 851cells/μl, a median of 831cells/μl , and a standard deviation of 254cells/μl . The expected (‘normal’) range, covering 95% of the sample was 438-1532 cells/μl. Participants with malaria parasitaemia tended to have a lower CD4 count (lower on average by 115 cells/μl, P Keywords: CD4 counts, HIV-negative, pregnancy

Recent Sex Trade and Injection Drug Use Among Opiate and Cocaine-dependent Pregnant Women in Treatment

OBJECTIVES: This study examined whether opioid and cocaine dependent pregnant women with psychiatric comorbidity were at elevated risk for infectious disease by virtue of recent sex trade and injection drug use that overlapped with pregnancy. We hypothesized that opioid and cocaine dependent women with psychiatric comorbidity would have greater odds for engaging in recent sex trade and injection drug use. METHODS: Eighty-one, HIV-seronegative pregnant women (59.3% African-American, 37% white, and 3.7% other) who were enrolled in drug treatment in Baltimore, Maryland were recruited into an HIV prevention intervention study, provided informed consent, and attended an in-person, baseline assessment administered by trained clinicians. Assessments included the The Structured Clinical Interview for DSM-IV-TR Axis I Disorders, the HIV Risk Behavior Interview, and a demographic questionnaire. The majority of women had lifetime histories of opioid and/or cocaine dependence (93.8%) and those with an additional lifetime non-substance-related Axis I disorder comprised the psychiatric comorbidity group. RESULTS: Thirty-percent reported recent sex trade and/or injection drug use that overlapped with pregnancy. While psychiatric comorbidity was associated with 6 times the odds of opioid and cocaine dependent pregnant women having recently traded sex it was not associated with recent injection drug use. CONCLUSIONS: Findings underscore the need to (1) treat comorbid psychiatric disorders among pregnant women in treatment for cocaine and opioid dependence and (2) integrate HIV prevention interventions into drug dependence treatment for pregnant women, particularly those with psychiatric comorbidity given their elevated risk for infectious disease.

Predictors of CD4+ lymphocyte count among HIV-seropositive and HIV-seronegative pregnant women in Dar es Salaam, Tanzania.

To determine the predictors of CD4+ lymphocyte count among pregnant women in Dar es Salaam, Tanzania. Between 04/1995 and 03/1997, HIV-seropositive (n=1,027) and HIV-seronegative (n=280) pregnant women were interviewed to obtain socio-demographic characteristics. Later, blood samples was collected for determination of T-lymphocyte subsets and other haematological indices. CD4+ lymphocyte count was significantly higher among HIV-seronegative women (mean=770 cells/mm3, standard deviation (SD)=232 cells/mm3) than HIV-seropositive women (mean=422 cells/mm3, SD=205 cells/mm3). Most HIV-seropositive women were asymptomatic, in WHO clinical stage 1 (84.3%). Among HIV-seropositive women, total white blood count (WBC) and erythrocyte sedimentation rate (ESR) remained significantly correlated with CD4+ after adjusting for other predictors in multivariate analyses. For women of average age 25 years, the CD4+ lymphocyte count increased by about 16 cells/mm3 for each increment of 1000 WBC cells/mm3, while each 10 mm/hr increase in ESR was associated with a reduction of CD4+ lymphocyte count of about 8 cells/mm3. These results show that simple and inexpensive haematological indices cannot be recommended for use as alternative measures of HIV-related immunosuppression in this population of mainly asymptomatic women.

Immunity to Measles in Pregnant Mothers and in Cord Blood of Their Infants: Impact of HIV Status and Mother’s Place of Birth

Antibody levels to measles were evaluated in 16 HIV-seropositive and 34 seronegative pregnant women and in cord blood samples of their infants. Infants were followed prospectively, and a second blood sample was taken at 3-7 months of age. Antibody levels were significantly lower in HIV-seropositive pregnant women and HIV-exposed cord bloods at birth (p=0.01 and 0.04, respectively) compared to controls. The prevalence of protective immunity (> or =1.09 optical density ratio) was also significantly lower (p=0.02) in HIV-seropositive pregnant women. T-cell counts were lower in HIV-seropositive women who were nonimmune (268/mm3) to measles compared to those who were immune (618/mm3), but the difference did not reach significance (p=0.07). Immunity to measles declined significantly to nonprotective levels in all infant samples obtained at 3-7 months of age. A secondary analysis determined the impact of mother's place of birth. Antibody levels were significantly higher (p=0.03) in foreign-born HIV-seronegative pregnant women and cord blood samples (p=0.01) compared to U.S.-born HIV-seronegative pregnant women seen in our inner-city clinic. Thus, HIV-seropositive and even some seronegative U.S.-born women may need a booster vaccine to ensure passage of adequate levels of passive immunity.

Serum Zinc, Copper, Selenium, Calcium, and Magnesium Levels in Pregnant and Non-Pregnant Women in Gondar, Northwest Ethiopia

Pregnant women in developing countries are vulnerable to multiple micronutrient deficiencies. Studies assessing serum levels of the micronutrients and magnitude of their deficiencies are very scarce in African subjects. This study was aimed at determining serum levels of micronutrients in 375 pregnant (42 HIV seropositive) and 76 non-pregnant women (20 HIV seropositive) who visited the University of Gondar Hospital, Gondar, Ethiopia. Serum concentrations of zinc,\ copper, selenium, calcium, and magnesium were determined using an inductively coupled plasma mass spectrometer. Irrespective of HIV serostatus, pregnant women had significantly higher serum concentrations of copper and copper/zinc ratio and significantly lower magnesium compared to those in non-pregnant women (P < 0.05). Except for selenium, which was significantly lower in HIV-seropositive pregnant women (P < 0.05), the mean serum concentrations of zinc, copper, calcium, and magnesium were not significantly different between pregnant women by HIV serostatus. The prevalence of deficiency in zinc, magnesium, selenium, and calcium in the pregnant women, irrespective of their HIV serostatus, was 66.7%, 25.6%, 21.9%, and 9.3%, respectively. The magnitude of deficiency in zinc, magnesium, and selenium was significantly higher in HIV seropositive pregnant women (76.2%, 52.4%, and 45.2%) than that in HIV-seronegative pregnant women (65.5%, 22.2%, and 18.9%) and in HIV-seronegative non-pregnant women (42.9%, 8.1%, and 30.4%; P < 0.05). Deficiency in one, two, three, or four mineral elements was observed in 44.8%, 14.4%, 9.9%, and 5.1% of the pregnant women, respectively. Only 25.9% of the pregnant women and 44.7% of the non-pregnant women were not deficient in any of the micronutrients. The high prevalence of micronutrient deficiencies in pregnant and non-pregnant women in Gondar, Ethiopia warrants the need for strategies on prevention and control of the deficiencies.