THE PLACENTA AS THE EPIDEMIC FACTOR OF VERTICAL HIV TRANSMISSION RISK IN CONDITIONS OF COMORBIDITY

A multifactorial in-depth study of 78 placentas obtained during delivery of HIV infected women in St. Petersburg between 2009 and 2011. We studied clinical anamnestic and laboratory parameters on the basis of the retrospective analysis, respectively, in 78 HIV-positive postpartum women (mean age 27,1±4,1 years) and their newborn children, of whom 12 have mother-to-child transmission of HIV. Most of the women who gave birth to infected children who were users of psychoactive drugs all took place co-infection with hepatitis C virus, about half of them were observed chronic urogenital infections. The complexity of communication, contacts instability did not allow any of the women who have realized the vertical transmission of HIV, antiretroviral therapy to conduct in full. In obstetrical establishment turned 11 women, but due to the onset of labor and/or premature rupture of membranes that are not allowed to use the elective caesarean section as a method of prevention of vertical transmission of HIV. All infants were signs posthypoxic encephalopathy. It was noted that in HIV infection in the placental tissue is imbalance between pro-angiogenic (VEGF, bFGF, CD31) and anti-angiogenic (TGF-β1, Tsp-1) factors in favor of the latter, which is the basis of a dissociated maturation chorionic villi and chronic placental insufficiency. With the implementation of intrauterine infection of HIV in placental tissue sharply reduced macrophage content, primarily CD68+ and, to a lesser extent, CD14+. Violation placental barrier greatly facilitates and determines the penetration of HIV to the fetus. In this case, targeted prevention, treatment for opportunistic infections and drug correction of placental insufficiency in HIV-infected women should, obviously, be regarded as justified pathogenetic approaches to reduce mother-to-child transmission of HIV.

ВИЧ-инфекция, вертикальная передача ВИЧ, плацента человека, HIV infection, mother-to-child transmission of HIV, human placenta

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