Exploring the impact of HIV infection and antiretroviral therapy on placenta morphology

• Published in: Placenta (Eastbourne) Vol. 104; pp. 102 - 109
• Main Authors: Yampolsky, Michael, Shlakhter, Oleksandr, Deng, Dianna, Kala, Smriti, Walmsley, Sharon L., Murphy, Kellie E., Yudin, Mark H., MacGillivray, Jay, Loutfy, Mona, Dunk, Caroline, Serghides, Lena
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 15.01.2021
• Subjects: Adult; Anti-Retroviral Agents - pharmacology; Anti-Retroviral Agents - therapeutic use; Female; HIV Infections - drug therapy; HIV Infections - pathology; HIV Infections - virology; Humans; Infant, Newborn; Marginal cord; Marginality; Placenta - drug effects; Placenta - pathology; Placenta - virology; Placenta shape; Pregnancy; Protease inhibitors; Small for gestational age; Umbilical Cord - drug effects; Umbilical Cord - pathology; Umbilical Cord - virology; Velamentous cord; Placenta shape; Marginality; Velamentous cord; Small for gestational age; Protease inhibitors; Marginal cord
• ISSN: 0143-4004; 1532-3102
• DOI: 10.1016/j.placenta.2020.12.004

Women living with HIV experience more adverse birth outcomes; the mechanisms are not fully understood. We examined placenta morphology and associations with birth outcomes in a Canadian cohort of women living with HIV (HIV+) on antiretroviral therapy (ART) from conception and HIV-uninfected (HIV−) women. Term placentas from 94 women (40 HIV−, 54 HIV+) were studied. Trimmed placenta weight was collected. Placenta digital photos were used to compute morphometric parameters. Regression models investigated associations between log-transformed placenta parameters and birth outcomes. We observed a trend towards lower placenta weight and smaller placenta area in the HIV+ group, both of which were significantly associated with small for gestational age births. HIV+ serostatus was associated with 6-fold (95%CI 2–20) greater odds of having placenta area in the lowest quartile (<236 cm2). Cord marginality (distance from the edge) was significantly lower in the HIV+ group (p = 0.004), with 35% of placenta having an abnormal (marginal or velamentous) cord insertion vs. 12.5% in the HIV− group (p = 0.01). Velamentous cord insertion was seen in 13% of placentas in the HIV+ vs. 0% in HIV− group (p = 0.02). A significant correlation between cord marginality and placenta thickness was observed in the HIV− group, with a more marginal cord being associated with a thicker placenta. This correlation was not observed in the HIV+ group. HIV+ placentas exposed to protease inhibitors were significantly less circular compared to the HIV− group (p = 0.03). Our data suggest that HIV/ART exposure affects placenta morphology and is associated with higher rates of abnormal cord insertion. •HIV-positive serostatus is associated with higher rates of abnormal umbilical cord insertion.•HIV-positive serostatus is associated with placentas with smaller area and lower weight.•Protease inhibitor exposure is associated with non-circular placentas.