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Maternal HIV infection alters the immune balance in the mother and fetus; implications for pregnancy outcome and infant health

Pfeifer, Caroline; Bunders, Madeleine J.

Current Opinion in HIV and AIDS: March 2016 - Volume 11 - Issue 2 - p 138–145
doi: 10.1097/COH.0000000000000239
IMMUNE ACTIVATION: Edited by Irini Sereti and Marcus Altfeld

Purpose of review With the rapid roll-out of combination antiretroviral therapy to prevent mother-to-child transmission of HIV, there is an annual increase in the number of uninfected infants born to HIV-infected women. Although the introduction of combination antiretroviral therapy has vastly improved pregnancy outcome and the health of infants born to HIV-infected women, concerns remain regarding the impact the maternal HIV infection on the pregnancy outcome and the health of HIV-exposed uninfected infants.

Recent findings Maternal HIV infection is associated with negative pregnancy outcomes such as low birth weight. In addition, an increased susceptibility to infections is reported in HIV-exposed uninfected infants compared with infants born to uninfected women. Studies have shown that HIV-exposure affects the maternal/fetal unit, with increase of proinflammatory cytokine produced by placental cells, as well as altered infant immune responses. These changes could provide the underlying conditions for negative pregnancy outcomes and facilitate mother-to-child transmission of HIV in the infant. Further studies are required to understand the underlying mechanisms and investigate whether these altered infant immune responses persist and have clinical consequences beyond childhood.

Summary HIV infection in pregnant women is associated with altered immune responses in HIV-infected women and their offspring with clinical consequences for pregnancy outcome and the HIV-exposed uninfected infant. Further studies are required to address the origin and long-term consequences of prenatal HIV-exposure and subsequent immune activation for infant health.

aDepartment of Virus Immunology, Heinrich-Pette Institute, Leibniz Institute for Experimental Virology, Hamburg, Germany

bDepartment of Experimental Immunology

cEmma Childrens Hospital, Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, The Netherlands

Correspondence to Madeleine J. Bunders, Department of Experimental Immunology, M01-118, Academic Medical Center, University of Amsterdam, Amsterdam, Meibergdreef 11, 1100 AZ, The Netherlands. Tel: +31205668294; e-mail:

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