Maternal Vaccination May Prevent Compromised Immunity in HIV-Exposed Children

Maternal vaccination in women with HIV infection may aid in the transfer of antigen-specific transplacental antibodies that confer protection against early-life infections among HIV-exposed uninfected (HEU) children. These findings were published in Clinical Infectious Diseases.

Between 2017 and 2018, researchers conducted a study that compared differences in antigen-specific transplacental antibody transfer between women with and without HIV infection. All women with HIV infection included in the analysis were receiving antiretroviral therapy (ART), and maternal blood was collected during labor. To characterize differences in antigen-specific transplacental antibody transfer between women with vs without HIV infection, the researchers performed a partial least squares discrimination analysis.

Enrolled patients (N=352) comprised 176 women with HIV infection and 176 without HIV infection. Among women with and without HIV infection, 139 and 135 were aged between 20 and 34 years, the mean gestational age was 39 and 39 weeks, and 109 and 90 were multiparous, respectively. Of women with HIV infection, the median CD4 count was 440 cells/mm³, 74% had an undetectable viral load, and 53% were started on ART prior to conception.

The researchers assessed umbilical cord plasma and found that global antibody transfer patterns were similar on the basis of HIV serostatus, indicating effective placental function among women with HIV infection who were receiving ART. On analysis of women with HIV infection and paired HIV-exposed umbilical cord plasma, there were increased concentrations of antibodies against Epstein-Barr and herpes simplex virus (P <.01). Further analysis, however, showed that concentrations of antibodies against tetanus, polio, and haemophilus influenzae type b were decreased (P <.01). The researchers attributed these differences in umbilical profiles to imbalanced immunity among women with HIV infection.

After performing multivariate regression, the researchers found that HIV viremia, decreased CD4 cell counts, and ART initiation after conception were associated with abnormal antibody profiles among women with HIV infection. Among women who were started on ART prior to conception and subsequently achieved effective immune reconstitution, transplacental antibody transfer was similar compared with those without HIV infection. Of note, although all women with HIV infection were on ART, 26% had detectable HIV viral loads.

This study was limited due to the lack of longitudinal follow-up and the inability to make adjustments for factors that may have affected maternal seroprofiles, including diet and nutrition and socioeconomic status.

According to the researchers, “…rebalancing maternal seroprofiles in women with HIV infection is [an] important step in helping HEU children battle the world of pathogens awaiting them after birth.”

Disclosure: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Dolatshahi S, Butler AL, Siedner MJ, et al. Altered maternal antibody profiles in women with HIV drive changes in transplacental antibody transfer. Clin Infect Dis. Published online March 4, 2022. doi:10.1093/cid/ciac156