Intestinal barrier dysfunction and microbial translocation in HIV-infected pregnant women is associated with preterm birth

Citation: Shivakoti R, Gupte N, Kumar NP, Kulkarni V, Balasubramanian U, Bhosale R, Sambrey P, Kinikar A, Bharadwau R, Patil S, Inamdar S, Suryavanshi N, Babu S, Bollinger RC, Gupta A. Intestinal barrier dysfunction and microbial translocation in HIV-infected pregnant women is associated with preterm birth. Clin Infect Dis. 2018 Sep 14;67(7):1103-1109. doi: 10.1093/cid/ciy253. PMID: 29590318 PMCID. PMC6137119 [Available on 2019-09-14].

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Background:
Preterm birth (PTB) rates are high in HIV-infected populations, even when on treatment. Still, only a subset of all births in HIV-infected pregnant women result in PTB, suggesting risk factors other than HIV infection itself are also important. Inflammation is a known risk factor in uninfected populations but their role in HIV-infected population have not been studied; in addition, the immune pathways involved are not clear and non-invasive immune markers with predictive value are lacking. Our objective was to determine the association of select markers of inflammation with PTB in HIV-1-infected pregnant women.

Methods:
Within a randomized trial of pregnant women receiving Nevirapine (SWEN trial), we nested a case-control study (n=107; 26 cases, 81 controls) to determine the association of maternal inflammation with PTB. Cases were defined as PTB (<37 weeks gestational age (GA)). We assessed inflammation by measuring plasma levels of markers of general inflammation (C-reactive protein (CRP)), intestinal barrier dysfunction (intestinal fatty acid binding protein (I-FABP)) and microbial translocation/monocyte activation (soluble CD14 (sCD14) and CD163 (sCD163)). Multivariable logistic regression was used to determine the odds of PTB per log2 increase of each marker.

Results:
In multivariable models, there was increased odds of PTB per unit increase of Log2 sCD14 (adjusted odds ratio (aOR): 2.45, 95% confidence interval (CI): 1.44-4.86), Log2 sCD163 (aOR: 3.87, 95% CI: 1.43-10.49) and Log2 I-FABP (aOR: 2.28, 95% CI: 1.18-4.41) but not Log2 CRP (aOR: 0.72, 95% CI: 0.48-1.09).

Conclusions:
Our results show select immune markers can identify women at higher risk for PTB in HIV-1-infected populations and suggest modulating gut barrier integrity and microbial translocation may affect PTB.

Clinical Infectious Diseases

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