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Background Early antiretroviral therapy (ART) during pregnancy has dramatically reduced the risk of perinatal HIV transmission. However, studies have shown an association between premature delivery and the use of ART during pregnancy (particularly protease inhibitor (PI)-based therapies), which could be explained by placental dysfunction. The objective of this study was to evaluate the association of ART (class, duration of exposure and time of initiation) with placental function by using angiogenic factors placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) as biomarkers. Methods Clinical and biological data from 159 pregnant women living with HIV were analyzed. Levels of each biomarker were measured in the first and second trimester of pregnancy. After logarithmic transformation, we compared these using generalized estimating equations according to (a) the type of ART; (b) the duration of exposure to ART; and (c) the time of initiation of ART. Results After adjusting for variables such as ethnicity, maternal age, gestational age, body mass index, parity, smoking status, and sex of the fetus, we found no significant association between the class of ART (PI-based or not) and serum concentrations of PlGF or sFlt-1. Furthermore, no significant association was found between biomarker levels and the duration of ART exposure or the timing of ART initiation (pre- or post-conception). Conclusions This study suggests that first and second trimester angiogenic factor levels are not significantly associated with ART, regardless of the duration or type (with or without PI). These observations seem reassuring when considering the use of ART during early pregnancy.

Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS) infection in children under 15 years is mostly due to mother to child transmission. The purpose of this study was to assess the outcome of infants born to HIV-positive women through the prevention of mother to child transmission (PMTCT) aspects at Sylvanus Olympio’s Teaching Hospital of Lome. This retrospective study of 24 months (from September 1, 2008 to September 1, 2010) was performed in 232 recorded files of infants delivered in the centre and monitored in the pediatrics department. From 230 women who had given birth to 232 infants, 224 (97.4%) knew their positive HIV status before delivery and 6 (2.6%) tested positive after child birth. Low birth weight was observed in 21.5% of newborns and 12.3% were born preterm. Two hundred seven (55.0%) infants were exclusively breastfed, with abrupt weaning at 4 months in 40.2% (39). Polymerase chain reaction (PCR) test was performed at 17 and 19 weeks in the 232 infants and 13 positive cases were found (5.6% transmission rate). An assessment of the centre in 2010 identified a mother-child transmission rate of HIV that was still high. There was need to strengthen screening strategies, counselling during antenatal care, and access to ART for all pregnant women. Key words: Prevention of mother to child transmission (PMTCT), human immunodeficiency virus (HIV) pregnant women, antiretroviral treatment, Togo, West Africa.

Objective: To evaluate the association of antiretroviral therapy (ART) type and duration of exposure with early placental function using biomarkers of aneuploidy screening. Study design: Three hundred thirty-eight pregnant women living with HIV were enrolled in two Canadian centers. Multiple linear regressions were performed adjusting for confounding factors (race, age, gestational age, body mass index, parity, smoking, and fetal sex). Results: Women receiving ART had significantly increased second trimester alpha-fetoprotein (AFP) levels (β = 0.147, 95% CI = [0.067–0.227] for protease inhibitor-based ART and β = 0.176, 95% CI = [0.080–0.272] for ART without protease inhibitor) compared to women who received no treatment. However, there was no significant association between ART type and the levels of free β-human chorionic gonadotrophin (β-hCG), pregnancy-associated plasma protein-A (first trimester), unconjugated estriol, total hCG, and inhibin A (second trimester). No significant association was shown between biomarker levels and duration of ART exposure. Conclusion: Early placental function does not appear to be significantly affected by ART, except for AFP.