Exploring the impact of HIV infection and antiretroviral therapy on placenta morphology

Placenta. 2021 Jan 15:104:102-109. doi: 10.1016/j.placenta.2020.12.004. Epub 2020 Dec 7.


Introduction: Women living with HIV experience more adverse birth outcomes; the mechanisms are not fully understood. We examined placenta morphology and associations with birth outcomes in a Canadian cohort of women living with HIV (HIV+) on antiretroviral therapy (ART) from conception and HIV-uninfected (HIV-) women.

Methods: Term placentas from 94 women (40 HIV-, 54 HIV+) were studied. Trimmed placenta weight was collected. Placenta digital photos were used to compute morphometric parameters. Regression models investigated associations between log-transformed placenta parameters and birth outcomes.

Results: We observed a trend towards lower placenta weight and smaller placenta area in the HIV+ group, both of which were significantly associated with small for gestational age births. HIV+ serostatus was associated with 6-fold (95%CI 2-20) greater odds of having placenta area in the lowest quartile (<236 cm2). Cord marginality (distance from the edge) was significantly lower in the HIV+ group (p = 0.004), with 35% of placenta having an abnormal (marginal or velamentous) cord insertion vs. 12.5% in the HIV- group (p = 0.01). Velamentous cord insertion was seen in 13% of placentas in the HIV+ vs. 0% in HIV- group (p = 0.02). A significant correlation between cord marginality and placenta thickness was observed in the HIV- group, with a more marginal cord being associated with a thicker placenta. This correlation was not observed in the HIV+ group. HIV+ placentas exposed to protease inhibitors were significantly less circular compared to the HIV- group (p = 0.03).

Conclusion: Our data suggest that HIV/ART exposure affects placenta morphology and is associated with higher rates of abnormal cord insertion.

Keywords: Marginal cord; Marginality; Placenta shape; Protease inhibitors; Small for gestational age; Velamentous cord.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-Retroviral Agents / pharmacology
  • Anti-Retroviral Agents / therapeutic use*
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / pathology*
  • HIV Infections / virology
  • Humans
  • Infant, Newborn
  • Placenta / drug effects
  • Placenta / pathology*
  • Placenta / virology
  • Pregnancy
  • Umbilical Cord / drug effects
  • Umbilical Cord / pathology*
  • Umbilical Cord / virology


  • Anti-Retroviral Agents