The University of Maryland School of Medicine's (UM SOM) Institute for Global Health (IGH) and the Institute of Human Virology (IHV) have been awarded a $2 million five-year grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to study the impact exposure to HIV has on the immune systems of infants in utero and how those changes impact the ability of infants to fight off infections after birth.
The research will be conducted at the IGH's long-standing research site in Blantyre, Malawi and will follow pregnant women during pregnancy until the infants reach nine months of age. Research will be conducted at the Blantyre Malaria Project (BMP) Research Clinic in the Ndirande Health Centre, which is an affiliate of the University of Malawi College of Medicine. UM SOM researchers have been conducting clinical studies among pregnant women and others living with HIV at this location since 1998.
The Principal Investigators for the UM SOM Grant are Cristiana Cairo, PhD, Assistant Professor of Medicine in IHV and Miriam K. Laufer, MD, MPH, Associate Professor of Pediatrics and Director of the Division of Malaria Research and Associate Director of IGH.
"Our long-term goal is to identify an approach for preventing mother-to-child transmission of HIV that also minimizes the impact of maternal infection on the immune development of infants exposed to HIV but not infected," said Drs. Cairo and Laufer.
The research comes as nearly 30 percent of all infants born in sub-Saharan Africa are exposed to HIV in utero but are uninfected at birth. It is estimated that in sub-Saharan Africa alone, more than 13.8 million women of childbearing age are living with HIV infection and more than 1.5 million HIV-positive women give birth each year.
Women in sub-Saharan Africa are routinely screened for HIV infection at their first pre-natal visit, which typically takes place at in the second or third trimester. They are then treated with antiretroviral treatment (ART) if diagnosed with HIV infection. While most infants prenatally exposed to HIV do not become infected as a result ART, these infants still have higher morbidity and mortality in the first two years of life due to common infections. The precise mechanism of the increased susceptibility to infection is not yet known and this study will provide one of the most in-depth immunological investigations to begin to understand this phenomenon.
Adaptive Immune Responses of Infants
UM SOM researchers will analyze the adaptive immune responses of infants with different HIV exposure in utero. They will compare if infants born to HIV-infected mothers who were on ART prior to conception are different from mothers who are first diagnosed with HIV infection and treated during their pregnancy. The first group of infants will be exposed to very low levels of HIV, while the second will be exposed to a high level of HIV infection throughout most of the mother's pregnancy
The study could ultimately lead to earlier HIV testing and related pre-natal care. "Early HIV testing in all women of child bearing age may have a significant impact on infant health and survival," said Dr. Laufer, who is also Director of the Division of Malaria Research and Associate Director of Institute of Global Health.
"It is of critical importance to clearly understand the impact of maternal HIV infection on exposed uninfected infant immunity, in order to identify the right strategy to improve the health of HIV-exposed infants throughout the world," said Dr. Cairo.