Evidence map›Paper›PMID 33606024›Full record

ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021

Low Immune Activation in Early Pregnancy Is Associated With Preterm But Not Small-for-gestational-age Delivery in Women Infected With Human Immunodeficiency Virus Initiating Antiretroviral Therapy in Pregnancy: A Prematurity Immunology in HIV-infected Mothers and their Infants Study (PIMS) Case-control Study in Cape Town, South Africa.

Nontlantla Mdletshe, Christina Thobakgale, Thokozile R Malaba, Hlengiwe Madlala, Landon Myer, Daniel M Muema, Polycarp Mogeni, Clive M Gray, Marcus Altfeld, Marie-Louise Newell and 1 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.2field-weighted citation impact, top 51% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 5 citations in OpenAlex.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 4 countries.

Nontlantla MdletsheHIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Christina ThobakgaleHIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
Thokozile R MalabaDivision of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Hlengiwe MadlalaDivision of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Landon MyerDivision of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Daniel M MuemaAfrica Health Research Institute, Durban, South Africa.
Polycarp MogeniAfrica Health Research Institute, Durban, South Africa.
Clive M GrayDivision of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.
Marcus AltfeldDepartment of Viral Immunology, Heinrich-Pette-Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany.
Marie-Louise NewellSchool of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Thumbi Ndung'uHIV Pathogenesis Programme, The Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban, South Africa.
University of Cape Town · ZAUniversity of KwaZulu-Natal · ZAAfrica Health Research Institute · ZALeibniz Institute of Virology (LIV) · DEUniversity of the Witwatersrand · ZA

Funding

Fogarty Global Health Fellows Coordinating CenterR25TW009340 · FIC · UNIV OF NORTH CAROLINA CHAPEL HILL · PI CHI, BENJAMIN H. · 2012 to 2016
$6.9M
Strategies to optimize ART services for maternal&child health: the MCH-ART studyR01HD074558 · NICHD · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI ABRAMS, ELAINE JANINE, MYER, BENJAMIN LANDON · 2012 to 2014
$2.9M
ART and risk of preterm delivery in a rural high HIV prevalence areaR01HD080385 · NICHD · UNIVERSITY OF SOUTHAMPTON · PI NEWELL, MARIE-LOUISE HENRICAFERNANDE · 2014 to 2019
$1.8M
DELTAS Africa Initiative # DEL-15-006Eunice Kennedy Shriver National Institute of Child Health and Human Development R01HD080385FIC NIH HHS #5R25TW009340FIC NIH HHS R25 TW009340National Institute of Child Health and Human Development 1R01HD074558NICHD NIH HHS R01 HD074558NICHD NIH HHS R01 HD080385NIH HHSWellcome TrustWellcome Trust 107752/Z/15/Z
6 · The paper itself

Abstract

backgroundMechanisms underlying an association between human immunodeficiency virus (HIV) or antiretroviral therapy (ART) during pregnancy with risk of preterm delivery (PTD) and small-for-gestational-age (SGA) remain unclear. We explored the association between cellular immune activation and PTD or SGA in women with HIV initiating ART during or before pregnancy.

methodsWomen with HIV enrolled at median 15 weeks' gestation, were analyzed for immune markers, and matched on ART initiation timing (15 women initiated pre- and 15 during pregnancy). There were 30 PTD (delivery <37 weeks), 30 SGA (weight for age ≤10th percentile) cases, and 30 controls (term, weight for gestational age >25th percentile) as outcomes. Lymphocytes, monocytes, and dendritic cell populations and their activation status or functionality were enumerated by flow cytometry.

resultsPTD cases initiating ART in pregnancy showed decreased CD8+ T cell, monocyte, and dendritic cell activation; increased classical (CD14+CD16-) and intermediate (CD14+CD16+) monocyte frequencies; and decreased inflammatory monocytes (CD14dimCD16+) compared with SGA cases and term controls (all P < .05). Allowing for baseline viral load, the immune markers remained significantly associated with PTD but only in women initiating ART in pregnancy. Lower monocyte activation was predictive of PTD. TLR ligand-induced interferon-α and macrophage inflammatory protein-1β levels in monocytes were significantly lower in PTD women initiating ART in pregnancy.

conclusionLow immune activation, skewing toward anti-inflammatory monocytes, and lower monocyte cytokine production in response to TLR ligand stimulation were associated with PTD but not SGA among women initiating ART in, but not before, pregnancy, suggesting immune anergy to microbial stimulation as a possible underlying mechanism for PTD in women initiating ART in pregnancy.

Indexed as

HIV InfectionsPregnancy Complications, InfectiousPremature BirthCase-Control StudiesFemaleHIVHumansInfantInfant, NewbornMothersPregnancySouth Africaadverse pregnancy outcomesantiretroviral therapyHIVmonocytes

Identifiers

PMID33606024
PMCPMC8677566
OpenAlexW3130481801

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.