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J Acquir Immune Defic Syndr. 2019 May 28. doi: 10.1097/QAI.0000000000002111. [Epub ahead of print]

Markers of Spontaneuous Preterm Delivery in Women living with HIV: Relationship with Protease Inhibitors and Vitamin D.

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Departments of Pediatrics, Medicine and Pathology, Anschutz Medical Center, University of Colorado Denver, Aurora, CO 80045.
Center for Biostatistics in AIDS Research (CBAR), Harvard T.H. Chan School of Public Health, Boston, MA 02115.
National Institute of Child Health and Human Development, Bethesda, MD.
University of California San Francisco, San Francisco, CA.
Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at the University of California, Los Angeles. Los Angeles, CA.
iC42 Clinical Research and Development, Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045.



Women living with HIV (WLHIV) have increased risk of spontaneous preterm delivery (SPTD). We sought to identify plasma predictors of SPTD and their correlations with factors that increase the risk of SPTD, such as vitamin D deficiency and use of protease inhibitors (PI).


Plasma was obtained from 103 WLHIV with SPTD (≤35 weeks gestation) and 205 controls with term deliveries (TD; ≥37 weeds) matched to cases 2:1 by race and gestational age at blood draw. TNFα, IFNγ, IL6, IL8, IL1β, IL18, IL17, GCSF, MCP1, IP10, sIL2Rα, sCD14, VEGFA, MCSF, GROα, MMP9, IL10, TGFβ, sCTLA4 and eicosanoids were compared between cases adjusting for known SPTD risk factors.


Participants had similar demographic characteristics, but cases had higher plasma HIV RNA, lower CD4 cells and more advanced HIV disease compared with controls. High sIL2Rα was associated with increased risk of SPTD. High sCD14, GCSF, PGF2α and 5-HEPE were marginally associated with increased risk of SPTD. Women who initiated PI-containing ART before or during the 1st trimester had higher levels of GCSF and 5-HEPE compared with women without such exposure before plasma collection. Vitamin D insufficiency was associated with higher inflammatory sCD14 and PGF2α, and lower anti-inflammatory 5-HEPE.


The best plasma predictor of SPTD in WLHIV was sIL2Rα, a marker of T cell activation. Markers of monocyte activation and eicosanoids were marginally increased in WLHIV and SPTD, suggesting that they may also play a role in the pathogenesis of this disorder.

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