HIV and the risk of direct obstetric complications: a systematic review and meta-analysis.

BACKGROUND: Women of reproductive age in parts of sub-Saharan Africa are faced both with high levels of HIV and the threat of dying from the direct complications of pregnancy. Clinicians practicing in such settings have reported a high incidence of direct obstetric complications among HIV-infected women, but the evidence supporting this is unclear. The aim of this systematic review is to establish whether HIV-infected women are at increased risk of direct obstetric complications. METHODS AND FINDINGS: Studies comparing the frequency of obstetric haemorrhage, hypertensive disorders of pregnancy, dystocia and intrauterine infections in HIV-infected and uninfected women were identified. Summary estimates of the odds ratio (OR) for the association between HIV and each obstetric complication were calculated through meta-analyses. In total, 44 studies were included providing 66 data sets; 17 on haemorrhage, 19 on hypertensive disorders, five on dystocia and 25 on intrauterine infections. Meta-analysis of the OR from studies including vaginal deliveries indicated that HIV-infected women had over three times the risk of a puerperal sepsis compared with HIV-uninfected women [pooled OR: 3.43, 95% confidence interval (CI): 2.00-5.85]; this figure increased to nearly six amongst studies only including women who delivered by caesarean (pooled OR: 5.81, 95% CI: 2.42-13.97). For other obstetric complications the evidence was weak and inconsistent. CONCLUSIONS: The higher risk of intrauterine infections in HIV-infected pregnant and postpartum women may require targeted strategies involving the prophylactic use of antibiotics during labour. However, as the huge excess of pregnancy-related mortality in HIV-infected women is unlikely to be due to a higher risk of direct obstetric complications, reducing this mortality will require non obstetric interventions involving access to ART in both pregnant and non-pregnant women

Suppression of erythroid development <it>in vitro</it> by <it>Plasmodium vivax</it>

<p>Abstract</p> <p>Background</p> <p>Severe anaemia due to dyserythropoiesis has been documented in patients infected with <it>Plasmodium vivax,</it> however the mechanism responsible for anaemia in vivax malaria is poorly understood. In order to better understand the role of <it>P. vivax</it> infection in anaemia the inhibition of erythropoiesis using haematopoietic stem cells was investigated.</p> <p>Methods</p> <p>Haematopoietic stem cells/CD34⁺ cells, isolated from normal human cord blood were used to generate growing erythroid cells. Exposure of CD34⁺ cells and growing erythroid cells to <it>P. vivax</it> parasites either from intact or lysed infected erythrocytes (IE) was examined for the effect on inhibition of cell development compared with untreated controls.</p> <p>Results</p> <p>Both lysed and intact infected erythrocytes significantly inhibited erythroid growth. The reduction of erythroid growth did not differ significantly between exposure to intact and lysed IE and the mean growth relative to unexposed controls was 59.4 ± 5.2 for lysed IE and 57 ± 8.5% for intact IE. Interestingly, CD34⁺ cells/erythroid progenitor cells were susceptible to the inhibitory effect of <it>P. vivax</it> on cell expansion. Exposure to <it>P. vivax</it> also inhibited erythroid development, as determined by the reduced expression of glycophorin A (28.1%) and CD 71 (43.9%). Moreover, vivax parasites perturbed the division of erythroid cells, as measured by the Cytokinesis Block Proliferation Index, which was reduced to 1.35 ± 0.05 (<it>P</it>-value < 0.01) from a value of 2.08 ± 0.07 in controls. Neither TNF-a nor IFN-g was detected in the culture medium of erythroid cells treated with <it>P. vivax,</it> indicating that impaired erythropoiesis was independent of these cytokines.</p> <p>Conclusions</p> <p>This study shows for the first time that <it>P. vivax</it> parasites inhibit erythroid development leading to ineffective erythropoiesis and highlights the potential of <it>P. vivax</it> to cause severe anaemia.</p