Maternal CD4 + microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section

• Published in: Early human development Vol. 98; pp. 49 - 55
• Main Authors: Buxmann, H, Reitter, A, Bapistella, S, Stürmer, M, Königs, C, Ackermann, H, Louwen, F, Bader, P, Schlößer, R.L, Willasch, A.M
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01-07-2016
• Subjects: Adult; Advanced Basic Science; CD4 + cell microchimerism; CD4-Positive T-Lymphocytes - virology; Cesarean Section - adverse effects; DNA, Viral - genetics; Female; HIV; HIV Infections - blood; HIV Infections - transmission; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Male; Mode of delivery; Mother-to-child transmission; Neonatal and Perinatal Medicine; Newborn; Pregnancy; Pregnancy Complications, Infectious - blood; ribonucleic acid; RNA; cluster of differentiation; combination of antiretroviral therapy; ITT; intention-to-treat; caesarean section; Ct; min; magnetic cell sorting; deoxyribonucleic acid; threshold cycle; Mode of delivery; polymerase chain reaction; mother-to-child transmission; CD; max; MACS; a-pH; EDTA; cART; CD4 + cell microchimerism; CS; Newborn; HIV; DNA; human immunodeficiency virus; maximum; MTCT; arterial cord blood pH; minimum; PCR; ethylenediamine tetraacetic acid; CD4+ cell microchimerism; Mother-to-child transmission
• ISSN: 0378-3782; 1872-6232
• DOI: 10.1016/j.earlhumdev.2016.06.004

Abstract Background Maternal CD4 + cell microchimerism may be greater after caesarean section compared to spontaneous vaginal delivery and could cause mother-to-child transmission (MTCT) in HIV-exposed newborns. Aims To evaluate maternal CD4 + cell microchimerism in HIV-exposed newborns after spontaneous vaginal delivery or caesarean section. Study design and subjects In this prospective single-centre study, neonates whose mothers were infected with HIV and had normal MTCT risk according to the German Austrian Guidelines were considered for study enrolment. Maternal CD4 + cell microchimerism in the newborns' umbilical cord blood was measured and compared by mode of delivery. Results Thirty-seven HIV-infected mothers and their 39 newborns were included in the study. None of the 17 (0.0%) newborns delivered vaginally had quantifiable maternal CD4 + cells (95% confidence interval (CI): 0.00–0.00) in their circulation at birth compared with four of 16 (25.0%) newborns delivered via planned caesarean section, who showed 0.01–0.66% maternal cells (95% CI: − 0.06–0.16; P = 0.02) in their circulation. The intention to treat analysis, which included six additional newborns delivered by unplanned caesarean section, showed quantifiable maternal CD4 + cells in one (0.05%; 95% CI: − 0.02–0.04) of 23 (4.3%) newborn at birth compared to four of 16 (25.0%) born via planned caesarean section (95% CI: − 0.06–0.16; P = 0.04). There was no MTCT in any of the newborns. Conclusion In this small cohort, spontaneous vaginal delivery in HIV-infected women with normal MTCT risk was associated with lower maternal CD4 + cell transfer to newborns compared to planned caesarean section.