HPTN 024 study: Histologic chorioamnionitis, antibiotics and adverse infant outcomes in a predominantly HIV-1–infected African population - 19/08/11
, Victor Mudenda, MD b, Jennifer S. Read, MD, MS, MPH c, Elizabeth R. Brown, PhD d, Moses Sinkala, MD, MPH a, e, Steve Kamiza, MBBS f, Francis Martinson, MD, PhD g, i, Ephata Kaaya, MD, PhD h, Irving Hoffman, PA, MPH i, Wafaie Fawzi, MD, DrPH j, Megan Valentine, PA-C k, Taha E. Taha, MD, PhD lfor the HPTN 024 Study Team
Abstract |
Objective |
Histologic chorioamnionitis has been associated with preterm birth and low birthweight. Our goal was to evaluate the relationship between polymorphonuclear cell and mononuclear cell placental infiltrations and adverse infant outcomes.
Study design |
Data from women who were enrolled in a trial of antibiotics for prevention of mother-to-child transmission of HIV-1 and of preterm birth were analyzed. Women who had HIV and women who did not have HIV were assigned randomly to either metronidazole 250 mg and erythromycin 250 mg at 20 to 24 weeks of gestation 3 times daily for 7 days and metronidazole 250 mg and ampicillin 500 mg every 4 hours during labor or identical placebos. Women with HIV were offered nevirapine at delivery for the prevention of mother-to-child transmission. At delivery, various placental sites were evaluated for polymorphonuclear cell and mononuclear cell infiltration.
Results |
Polymorphonuclear and mononuclear cell infiltrations were common in the decidua (18% and 43%, respectively) and chorioamnion (28% and 34%, respectively). Gestational age and birthweight were lower among women with polymorphonuclear cell infiltrations, with these relationships generally stronger at earlier gestational age and birthweight. Mononuclear infiltrations were not associated with adverse outcomes. Neither polymorphonuclear cell nor mononuclear placental infiltrations were associated with mother-to-child transmission of HIV. Antibiotic use was not associated with reduced polymorphonuclear or mononuclear cell infiltrations.
Conclusion |
Polymorphonuclear cell infiltrations were associated with preterm birth and decreased birthweight and gestational age. Antibiotic use was not associated with reductions in polymorphonuclear or mononuclear cell infiltrations. In this nevirapine-treated population, neither polymorphonuclear nor mononuclear cell infiltration was associated with the mother-to-child transmission of HIV.
Le texte complet de cet article est disponible en PDF.Key words : Preterm birth, Chorioamnionitis, Africa
Plan
| Supported by the HIV Network for Prevention Trials (HIVNET) and sponsored by the US National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Department of Health and Human Services, through contract N01-AI-35173 with Family Health International; contract N01-AI-45200 with Fred Hutchinson Cancer Research Center; and subcontract N01-AI-35173-117/412 with Johns Hopkins University; and by the HIV Prevention Trials Network (HPTN) and sponsored by the National Institute of Allergy and Infectious Diseases, National Institute of Child Health and Human Development, National Institute on Drug Abuse, National Institute of Mental Health, and Office of AIDS Research, of the National Institutes of Health, US Department of Health and Human Services, Harvard University (U01-AI-480006), Johns Hopkins University (U01-AI-48005), and the University of Alabama at Birmingham (U01-AI-47972). Nevirapine (Viramune) for the study was provided by Boehringer Ingelheim Pharmaceuticals, Inc. The conclusions and opinions expressed in this paper are those of the authors and do not necessarily reflect those of the funding agencies and participating institutions. Presented at the 26th Annual Meeting of the Society for Maternal Fetal Medicine, January 30-February 4, 2006, Miami, FL. Reprints not available from the authors. Address correspondence to: Robert L. Goldenberg, MD, Department of Obstetrics/Gynecology, 1500 6th Ave South, CRWH 379, Birmingham, AL 35233-1602. |
Vol 195 - N° 4
P. 1065-1074 - octobre 2006 Retour au numéro
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