Unique Profile of Inflammation and Immune Activation in Pregnant People With HIV in the United States

J Infect Dis. 2023 Mar 1;227(5):720-730. doi: 10.1093/infdis/jiac501.


Background: Little is known about inflammation/immune activation during pregnancy in people with HIV (PWH) and growth in their children who are HIV-exposed and uninfected (CHEU).

Methods: Using data from the Pediatric HIV/AIDS Cohort Study and an HIV-seronegative comparison group, we assessed associations of (1) HIV status, mode of HIV acquisition (perinatally vs nonperinatally acquired), and type of antiretroviral therapy (ART) with inflammation/immune activation in pregnancy; and (2) inflammation/immune activation in pregnancy with growth of CHEU at 12 months. Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), soluble(s) TNF-α receptor 1 and 2 (sTNFR1, sTNFR2), sCD14, and sCD163 were measured between 13 and 27 weeks' gestation. Linear regression models were fit to estimate differences between groups for each log-transformed biomarker, adjusted for confounders.

Results: Pregnant PWH (188 total, 39 perinatally acquired, 149 nonperinatally acquired) and 76 HIV-seronegative persons were included. PWH had higher IL-6, sTNFR1, sCD14, and sCD163 and lower sTNFR2 compared to HIV-seronegative persons in adjusted models. Among PWH, sCD163 was higher in those with perinatally versus nonperinatally acquired HIV and on PI-based versus INSTI-based ART. Higher maternal concentrations of IL-6, sTNFR2, and hs-CRP were associated with poorer growth at 12 months.

Conclusions: Maternal HIV status is associated with a distinct profile of inflammation/immune activation during pregnancy, which may influence child growth.

Keywords: HIV; HIV-exposed uninfected; immune activation; inflammation; pediatrics; pregnancy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Acquired Immunodeficiency Syndrome* / complications
  • Biomarkers
  • C-Reactive Protein
  • Child
  • Cohort Studies
  • Female
  • HIV Infections* / complications
  • Humans
  • Inflammation
  • Interleukin-6
  • Lipopolysaccharide Receptors
  • Pregnancy
  • United States


  • C-Reactive Protein
  • Interleukin-6
  • Lipopolysaccharide Receptors
  • Biomarkers