Choriodecidual Inflammation: a Potentially Preventable Cause of Perinatal HIV-1 Transmission?

Important note: Information in this article was accurate in 1998. The state of the art may have changed since the publication date.

Choriodecidual Inflammation: a Potentially Preventable Cause of Perinatal HIV-1 Transmission?

Lancet (12/12/98) Vol. 352, No. 9144, P. 1927
Goldenberg, Robert L.; Vermund, Sten H.; Goepfert, Alice R.; et al.

Researchers from the University of Alabama at Birmingham hypothesize that preterm chorioamnionitis and acute chorioamnionitis at term are important components in the perinatal transmission of HIV-1. They state that preterm birth, prolonged rupture of the chorioamniotic membranes, and clinical and histological bacterial chorioamnionitis are obstetric risk factors for the vertical transmission of HIV-1 from mother to child. According to the authors, research shows a connection between chronic chorioamnionitis and preterm birth. The increased transmission rate among preterm infants could be due to an immature immunological system, but it may also be associated with pre-existing bacterial chorioamnionitis. Additionally, amniotic fluid cytokines are raised in the presence of term and preterm intrauterine infections, and the cytokines may attract HIV-1-infected leukocytes into the amniotic cavity, increasing HIV-1 replication. The researchers further postulate that the association of prolonged membrane rupture with HIV-1 transmission could be due to long-term exposure of vaginal fluid infected with HIV-1. Cesarean sections have reportedly been protective against transmission when performed before labor or soon after the rupture of membranes, which, the authors note, is before the development of chorioamnionitis. Targeting chorioamnionitis with antibiotics and microbicides could lead to reductions in the vertical transmission of HIV- 1. The researchers recommend studies on the matter, asserting that the benefits from treatment could be very cost-effective.

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