Division of Immunology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa; Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa.
Placenta. 2021 Nov;115:27-36. doi: 10.1016/j.placenta.2021.09.006. Epub 2021 Sep 11.
Recognizing the importance of placental features and their unique functions can provide insight into maternal health, the uterine environment during the course of pregnancy, birth outcomes and neonatal health. In the context of HIV and antiretroviral therapy (ART), there have been great strides in the prevention of mother to child transmission of HIV. However, there is still paucity of data on the impact of HIV/ART exposure on placental pathology and studies available only examine specific patterns of placental injury, further justifying the need for a more defined and comprehensive approach to the differential diagnoses of HIV/ART-exposed placentae. The purpose of this review is to consolidate findings from individual studies that have been reported on patterns of placental injury in the context of HIV/ART exposure. In both the pre- and post-ART eras HIV and/or ART has been associated with placental injury including maternal vascular malperfusion as well as acute and chronic inflammation. These patterns of injury are further associated with adverse birth outcomes including preterm birth and current evidence suggests an association between poor placental function and compromised fetal development. With the ever increasing number of pregnant women with HIV on ART, there is a compelling need for full incorporation of placental diagnoses into obstetric disease classification. It is also important to take into account key elements of maternal clinical history. Lastly, there is a need to standardize the reporting of placental pathology in order to glean additional insight into the elucidation of HIV/ART associated placental injury.
认识到胎盘特征及其独特功能的重要性，可以深入了解产妇健康、妊娠过程中的子宫环境、分娩结局和新生儿健康。在 HIV 和抗逆转录病毒治疗 (ART) 的背景下，预防母婴传播 HIV 方面已经取得了巨大进展。然而，关于 HIV/ART 暴露对胎盘病理的影响的数据仍然很少，现有的研究仅检查了胎盘损伤的特定模式，这进一步证明需要更明确和全面的方法来对 HIV/ART 暴露的胎盘进行鉴别诊断。本综述的目的是整合已发表的关于 HIV/ART 暴露背景下胎盘损伤模式的个别研究结果。在 ART 应用前后，HIV 和/或 ART 与胎盘损伤有关，包括母体血管灌注不良以及急性和慢性炎症。这些损伤模式与不良分娩结局进一步相关，包括早产，目前的证据表明，胎盘功能不良与胎儿发育受损之间存在关联。随着越来越多的 HIV 阳性孕妇接受 ART 治疗，迫切需要将胎盘诊断纳入产科疾病分类。考虑到母体临床病史的关键要素也很重要。最后，需要标准化胎盘病理报告，以便更深入地了解 HIV/ART 相关胎盘损伤。
