title: Placental pathology in HIV infection at term: a comparison with HIV-uninfected women.
abstract: To describe and correlate placental characteristics from pregnancies in HIV-infected and HIV-negative women with maternal and infant clinical and immunological data.
  
  
  
  Prospective descriptive study of placentas from term, uncomplicated vaginal births in a cohort of HIV-infected (n = 120) and HIV-negative (n = 103) women in Cape Town, South Africa. Microscopic and macroscopic features were used to determine pathological cluster diagnoses. The majority of HIV-infected women received some form of drug treatment for the prevention of vertical transmission of HIV. Data were analysed using logistic regression.
  
  
  
  HIV-infected women were older (median [IQR] 27.4 years [24-31] vs. 25.8 [23-30]), more likely to be multiparous (81.7% vs. 71.8%) and had lower CD4 counts (median [IQR] 323.5 cells/ml [235-442] vs. 467 [370-656]). There were no differences in gestational age at first antenatal visit or at delivery. The proportion of specimens with placental lesions was similar in both groups (39.2% vs. 44.7%). Half of all samples were below the tenth percentile expected-weight-for-gestation regardless of HIV status. This was unaffected by adjustment for confounding variables. Maternal vascular malperfusion (MVM) was more frequent in HIV infection (24.2% vs. 12.6%; P = 0.028), an association which strengthened after adjustment (aOR 2.90 [95% confidence interval 1.11-7.57]). Otherwise the frequency of individual diagnoses did not differ between the groups on multivariate analysis.
  
  
  
  In this cohort of term, uncomplicated pregnant women, few differences were observed between the HIV-infected and uninfected groups apart from MVM. This lesion may underlie the development of hypertensive disorders of pregnancy, which have been observed at higher rates in some HIV-infected women on ART.
authors.affiliation: Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Emma
authors.initials: E
authors.lastname: Kalk
authors.affiliation: Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa.
authors.forename: Pawel
authors.initials: P
authors.lastname: Schubert
authors.affiliation: Department of Pediatrics, Vaccine Evaluation Center, University of British Columbia, Vancouver, Canada.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Bettinger
authors.affiliation: Family Infectious Diseases Research Unit, Stellenbosch University, Cape Town, South Africa.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Cotton
authors.affiliation: Immunology Unit, Medical Microbiology, National Health Laboratory Services, Stellenbosch University, Cape Town, South Africa.
authors.forename: Monika
authors.initials: M
authors.lastname: Esser
authors.affiliation: Family Infectious Diseases Research Unit, Stellenbosch University, Cape Town, South Africa.|School of Population & Public Health, University of British Columbia, Vancouver, Canada.
authors.forename: Amy
authors.initials: A
authors.lastname: Slogrove
authors.affiliation: Division of Anatomical Pathology, Stellenbosch University, Cape Town, South Africa.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Wright
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001724:Birth Weight; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000473:pathology*; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D010920:Placenta / Q000473:pathology*; D049590:Postpartum Period; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000473:pathology*; D011446:Prospective Studies; D013019:South Africa; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV infection; bajo peso placentario; embarazo a término; faible poids placentaire; grossesse à terme; histopathologie; histopathology; histopatología; infección por VIH; infection VIH; low placental weight; mala perfusión placentaria; maternal vascular malperfusion; mauvaise vascularisation maternelle; placenta; term pregnancy