There are substantive global efforts to eliminate perinatal transmission of HIV (mother to child transmission), primarily utilizing access to antiretroviral therapy (ART) on an enormous scale. Understanding the impact of these treatments during pregnancy is paramount to ensuring prevention of perinatal HIV transmission does not also carry additional adverse health burdens.
HIV infection itself and ART have been associated with adverse perinatal outcomes, such as preterm delivery, fetal growth restriction (small weight for gestational age at delivery) and preeclampsia (severe maternal condition with high blood pressure). However, to date, adverse perinatal outcomes in HIV-infected women have not been well understood. Therefore, we will use data from the Centre Materno-Infantile sur le SIDA (CMIS, CHU Sainte-Justine, Montreal, Qc) and from the British Columbia referral centre (Oak Tree Clinic, BC Women's Hospital, Vancouver, BC) to comprehensively describe these outcomes in the Canadian setting and to explore their causes.
The multifactorial physiopathology of adverse perinatal outcomes implicates immunologic and inflammatory processes, perturbed placental formation and hormonal imbalance. To understand the impact of ART and HIV infection we will use: (1) Maternal serum levels of biomarkers used for aneuploidy screening, which are associated with adverse perinatal outcomes in the absence of foetal anomaly; (2) Specific assay of inflammatory markers such as cytokines, hormones such as progesterone, and others, which will be performed on samples from the CMIS biobank.
Results from these investigations will provide information on the specific needs of HIV-infected pregnant women and inform clinical guidelines with regards to best ART in pregnancy.