The impact of maternal HIV infection on cord blood lymphocyte subsets and cytokine profile in exposed non-infected newborns.

BACKGROUND: Children born to HIV+ mothers are exposed intra-utero to several drugs and cytokines that can modify the developing immune system, and influence the newborn's immune response to infections and vaccines. We analyzed the relation between the distribution of cord blood lymphocyte subsets and cytokine profile in term newborns of HIV+ mothers using HAART during pregnancy and compared them to normal newborns. METHODS: In a prospective, controlled study, 36 mother-child pairs from HIV+ mothers and 15 HIV-uninfected mothers were studied. Hematological features and cytokine profiles of mothers at 35 weeks of pregnancy were examined. Maternal and cord lymphocyte subsets as well as B-cell maturation in cord blood were analyzed by flow cytometry. The non-stimulated, as well as BCG- and PHA-stimulated production of IL2, IL4, IL7, IL10, IL12, IFN-γ and TNF-alpha in mononuclear cell cultures from mothers and infants were quantified using ELISA. RESULTS: After one year follow-up none of the exposed infants became seropositive for HIV. An increase in B lymphocytes, especially the CD19/CD5+ ones, was observed in cord blood of HIV-exposed newborns. Children of HIV+ hard drug using mothers had also an increase of immature B-cells. Cord blood mononuclear cells of HIV-exposed newborns produced less IL-4 and IL-7 and more IL-10 and IFN-γ in culture than those of uninfected mothers. Cytokine values in supernatants were similar in infants and their mothers except for IFN-γ and TNF-alpha that were higher in HIV+ mothers, especially in drug abusing ones. Cord blood CD19/CD5+ lymphocytes showed a positive correlation with cord IL-7 and IL-10. A higher maternal age and smoking was associated with a decrease of cord blood CD4+ cells. CONCLUSIONS: in uninfected infants born to HIV+ women, several immunological abnormalities were found, related to the residual maternal immune changes induced by the HIV infection and those associated with antiretroviral treatment. Maternal smoking was associated to changes in cord CD3/CD4 lymphocytes and maternal hard drug abuse was associated with more pronounced changes in the cord B cell line.

A supressao do Aleitamento materno e o HIV / Breast feeding suppression and HIV

O crescimento da epidemia de AIDS entre as mulheres levou, consequentemente, ao aumento do numero de casos em criancas, pois a grande maioria e devido a transmissao vertical do hiv, cuja probalidade de ocorrencia foi demonstrada em varios estudos. Foi evidenciado que a maioria dos casos, cerca de 65 porcento, ocorre durante o trabalho de parto e no parto propriamente dito e os 35 porcento restantes ocorrem intra-utero, principalmente nas ultimas semanas de gestacao; o aleitamento materno representa risco adicional de transmissao de 7 porcento a 22 porcento. A evidencia de transmissao do HIV pela amamentacao levou o Ministerio da Saude a contra-indicar o aleitamento materno por mulheres portadoras do HIV, assim como o aleitamento cruzado (feito por outra mulher). O presente artigo apresenta consideracoes sobre a utilizacao do teste rapido para pesquisa do HIV nas parturientes e sobre a importancia da supressao da lactacao nas mulheres HIV+, descrevendo os metodos que podem ser recomendados