Antenatal and postpartum immunological markers levels in women with HIV infection and malnutrition in a low resource setting: A pilot study

Abstract

Objectives: Both, Human Immunodeficiency Virus (HIV) infection and malnutrition are major challenges in pregnancy and postpartum in low-resource settings and the respective cytokine levels remain poorly described. The main objectives of this study were to find immune markers that are associated with HIV infection and malnutrition in pregnant women and to determine how these would change at 14 weeks postpartum. Method: Pregnant women of at least 20 weeks gestational age were enrolled into this longitudinal observational single centre pilot study at 4 primary health clinics in high-density areas around Harare, Zimbabwe. Socio-demographic and clinical data including plasma samples were collected in pregnancy and 14 weeks postpartum (PP). Mid-upper-arm circumference (MUAC) ≤23 cm was used as an indicator for malnourishment. Fifty-six cytokines and chemokines were assayed in plasma using the Mesoscale multiplex assay. We determined cytokine/chemokine levels including markers for vascular injury in HIV-infection and malnutrition. Associations remaining significant after multiple test correction were confirmed in multivariable analyses after controlling for confounders. Results: Ninety-seven pregnant women were recruited for this study and from these, 44 were randomly selected for cytokine assaying of which 20 HIV infected, 15 malnourished, and 9 well-nourished HIV uninfected participants. HIV infection was associated with significantly higher interleukin (IL)-4 ( q < 0.05) and IL-10 ( q < 0.001) in pregnancy. Longitudinally, IL-4 ( q < 0.01) and IL-10 ( q < 0.001) significantly increased in HIV uninfected women whilst in the HIV-infected both were non-significantly decreased. IL-8 (q < 0.05) levels significantly increased in HIV-infected women from pregnancy to 14 weeks PP. Vascular Cell Adhesion Molecule 1 (VCAM-1) ( q < 0.05) and interleukin-1 receptor antagonist (IL-1RA) ( q < 0.05) were significantly lower in malnourished women in pregnancy and 14 weeks PP, respectively. Conclusions: IL-4, IL-8, IL-10, and VCAM-1 are potential biomarkers for monitoring immune functioning in HIV-infected pregnant women and malnutrition. However, studies with larger sample size are warranted to confirm these findings.