Analysis of immunological markers associated with pregnancy and HIV-1 infection: relevance in perinatal transmission in HIV-1-infected pregnant women with low plasma viral load.

PROBLEM: In HIV-1-infected pregnant women with low plasma viral load, risk factors associated with perinatal HIV-1 transmission are not clearly understood. METHOD OF STUDY: We analyzed distribution of peripheral CD8 T-cell subsets, plasma cytokines and measured secretory leukocyte peptidase inhibitor (SLPI) and myeloid-related protein (MRP)-8 levels in whole-blood and cervico-vaginal fluid (CVF) specimens obtained from 35 HIV-1-infected pregnant women (group 1), 12 HIV-1-infected non-pregnant women (group 2) and 15 HIV-1 uninfected pregnant women (group 3). RESULTS: The group 1 women had higher expression of CD38, human leukocyte antigen-DR and CD95 on CD8 T-cells and higher levels of plasma tumor necrosis factor-alpha and epidermal growth factor. CVF-SLPI levels were the highest in group-3, while MRP-8 levels were the highest in group 1 women in plasma and CVF (P < 0.01). Although there were no cases of perinatal HIV-1 transmission, group 1 women undergoing HIV-1-indicated cesarean section had lower levels of CVF-SLPI as compared with those undergoing normal vaginal delivery. CONCLUSION: Pregnancy contributes to the activation of peripheral CD8 T cells and increase in pro-inflammatory cytokines. Production of protective mucosal secretory factors such as SLPI is affected by HIV-1 infection in pregnant women and down-regulated SLPI levels may indirectly indicate a higher possibility of perinatal HIV-1 transmission.

Plasma levels of alpha-defensins 1-3 are an indicator of neutrophil activation in pregnant and post-partum women.

AIM: In severe preeclampsia and septic shock, excessively activated neutrophils are thought to injure tissue irreversibly. On the other hand, mild neutrophil activation is known to occur during normal pregnancy. The objective of this study was to determine whether elevated plasma levels of alpha-defensins 1-3 could be used as an indicator of neutrophil activation in pregnant and post-partum women. METHODS: Defensin concentrations in 21 non-pregnant women and men, 184 normal pregnant women, and 55 post-partum women were quantified using an enzyme-linked immunosorbent assay (ELISA). The expression of the surface markers, CD11b and Toll-like receptor-4 (TLR-4), on the neutrophils were analyzed by flow cytometry in a cohort of subjects different from that used for the analysis of alpha-defensin levels. RESULTS: The concentrations of alpha-defensins were significantly higher in women that were in labor than in any of the other subjects. These levels diminished after delivery, but remained significantly elevated at one month post-partum. The expression of both CD11b and TLR-4 was significantly higher in women in labor compared to non-pregnant donors (controls). CD11b expression remained high on the third post-partum day, while TLR-4 expression fell to non-pregnant levels. CONCLUSION: Our results suggest that there is a positive association between defensin levels and neutrophil activation in pregnant and post-partum women.

Re-evaluation of the true rate of hepatitis C virus mother-to-child transmission and its novel risk factors based on our two prospective studies.

OBJECTIVE: To re-evaluate the true hepatitis C virus (HCV) mother-to-child transmission (MTCT) rate and its novel risk factors. STUDY DESIGN: A comparative study based on our own two prospective studies done during the two periods, 'early' (1989-1994) and 'recent' (1995-2004). RESULTS: All carrier infants became HCV RNA-positive within 3 months after birth. The MTCT and de-carrier rates were, respectively, higher (14.2%) and lower (16.7%) in the recent period, although liver dysfunction of carrier infants was found very frequently (66.7%) in both groups. MTCT occurred significantly when the maternal viral load, serum alanine aminotransferase (sALT) levels and blood loss at delivery were, respectively, more than 10(5) copies/mL, 110 IU/L, and 500 g. No MTCT was found when elective cesarean section was done. CONCLUSIONS: The true HCV MTCT and de-carrier rates were found to be much higher and lower than those reported previously. The maternal liver dysfunction (sALT >or=110 IU/mL) and blood loss (>or=500 g) at delivery are the next risk factors to maternal viral load (>or=10(5) copies/mL) for MTCT.

Outcome of prolapsed chorioamniotic membrane: relationship between the degree of herniation, infection, and pregnancy prolongation.

Our objective was to determine the outcome predictor of conservative bed rest therapy for prolapsed chorioamniotic membrane. We could perform tocolysis for 61 women, 41 of visible membrane (group A) and 20 of protruding membrane (group B). The duration of pregnancy prolongation and gestational age (in weeks) at delivery in group A were significantly larger than in group B ( p < 0.05). Outcome of neonates was also significantly different between two groups ( p < 0.05). In 37 women of group A (90%) and 10 of group B (50%; group D), signs of infection were negative throughout the admission to delivery with conservative therapy (white blood cell counts