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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Immune activation markers in peripartum women in Botswana: Association with feeding strategy and maternal morbidity
PLoS ONE, Volume 9, No. 3, Article e89928, Year 2014
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Description
Hormone levels shift the immune state in HIV-uninfected pregnant and breastfeeding women away from Th1 responses and toward regulation to permit fetal tolerance. Limited data exist on inflammation during pregnancy or postpartum in HIV-infected women, though certain inflammatory markers are associated with adverse health outcomes among HIV-infected persons. We measured hsCRP, D-dimer, IFN-γ, IL-6, IL-10 and TNF-α at 34 weeks gestation and six months postpartum in HIV-infected women from the Botswana Mashi PMTCT trial who were randomized to breastfeeding or formula-feeding. Differences in inflammatory markers between gestation and postpartum periods, and by randomized feeding method, were estimated using generalized estimating equations, adjusting for baseline plasma HIV-1 viral load, CD4 count, calendar time, and antiretroviral treatment status. Additionally, we studied the association between marker concentrations at six months postpartum and major adverse clinical events over the following 4.5 years, using case-cohort sampling and adjusted Cox proportional hazards models. In 86 breastfeeding and 75 formula-feeding women, hsCRP and D-dimer decreased significantly between 34 weeks gestation and six months postpartum, while IFN-γ increased. There was no significant association between inflammatory marker change and randomized feeding method after adjusting for multiple comparisons and removing outliers. In univariate analysis, TNF-α, D-dimer, and IFN-γ concentrations at six months postpartum were significant predictors of subsequent clinical events, and TNF-α remained significant in multivariate analysis (HR = 4.16, p = 0.001). In young HIV-infected women in Botswana inflammatory marker concentrations did not differ significantly between women who breast- vs. formula-fed. However, postpartum TNF-α level was predictive of subsequent adverse clinical event. © 2014 Russell et al.
Authors & Co-Authors
Russell, Elizabeth S.
United States, Boston
Harvard T.h. Chan School of Public Health Aids Initiative
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
United States, Frankfort
Kentucky Department for Public Health
Mohammed, Terence
United States, Boston
Harvard T.h. Chan School of Public Health Aids Initiative
Smeaton, Laura M.
United States, Boston
Center for Biostatistics in Aids Research
Jorowe, Baitshepi
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
MacLeod, Iain J.
United States, Boston
Harvard T.h. Chan School of Public Health Aids Initiative
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Hoffman, Risa M.
United States, Los Angeles
David Geffen School of Medicine at Ucla
Currier, Judith Silverstein
United States, Los Angeles
David Geffen School of Medicine at Ucla
Moyo, Sikhulile M.
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Essex, Max E.
United States, Boston
Harvard T.h. Chan School of Public Health Aids Initiative
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
Lockman, Shahin
United States, Boston
Harvard T.h. Chan School of Public Health Aids Initiative
Botswana, Gaborone
Botswana Harvard Aids Institute Partnership
United States, Boston
Brigham and Women's Hospital
Statistics
Citations: 10
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1371/journal.pone.0089928
e-ISSN:
19326203
Research Areas
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Botswana
Participants Gender
Female