Dynamics of T-Lympocyte counts in conjoint cases of human immunodeficiency virus and pregnancy: A perspective study in Western Kenya

Abstract

Dysregulation of Th1 and Th2 Type of Cytokines in Conjoint Cases of Human Immunodefeciency Virus and Pregnancy: A Longtidunal Study in Western Kenya Stanslaus K. Musyoki1, 2*, Kiprotich Chelimo2, Simeon K. Mining3, Collins Ouma2, 4 1; School of Health Sciences, Kisii University, P.O Box 408-40200, Kisii, Kenya 2; Department of Biomedical Science and Technology, Maseno University, Private Bag, Maseno, Kenya 3; Department of Immunology, Moi University, P.O. Box 4606-30100 Eldoret, Kenya 4; Health Challenges and Systems, African Population and Health Research Center, P.O. Box 10787, Nairobi, Kenya E-mail addresses for authors: SKM (stanstylo@gmail.com ); KC (chelimokip@yahoo.co.uk ); SM (smining57@gmail.com ); and CO (collinouma@yahoo.com )*Corresponding author ABSTRACT Pregnancy and HIV infection present a complex mix of diverse perturbations of immune system. Pregnant HIV-infected women have been reported to have a significantly higher risk of complicated outcomes of pregnancy and childbirth. Some cytokines produced in pregnancy are beneficial for the fetal growth: IL-4 and IL-10, where others seem deleterious: IL-2, IFN-γ, and TNF. However, the precise shift of systemic cytokines and the thin balance of these cytokines in HIV-infected pregnant women are scantly available and not clear. AMPATH is the largest HIV/AIDS treatment and care program in Kenya with a mean of 25,000 pregnant HIV-positive women under care annually giving undue advantage to undertake any study in relation to HIV. Despite the large numbers of HIV-positive pregnant women in this program, the immunological consequence of the conjoint presence of pregnancy and HIV infection remains unknown. The main aim of the study was to determine the effect of HIV infection on systemic cytokines in advancing pregnancy. Thus, this study specifically determined and compared trends, changes and differences in systemic cytokines [T-helper type 1 (IL-2, IFN-γ, TNF) and T-helper type 2 (IL-10, IL-6, IL-4)] levels longitudinally in the first, second and third trimesters of advancing pregnancies of HIV-infected and non-infected women. In a prospective cohort study design, 44 HIV-infected and 44 HIV-non-infected pregnant women were recruited for the study based on the study population at AMPATH/MTRH in Eldoret, western Kenya. The systemic cytokines were analyzed by flow cytometry. Data analysis was performed using STATA version 13 special edition. Significance levels were tested at P≤0.05. The trends of the Th1/Th2 cytokines were inconsistent in both groups. Among the HIV-positive women, significant changes of IL-2 [in the second trimester (P=0.003) compared to first and in the third trimester (P=0.003) compared to second trimester], IL-6 [in the second trimester (P=0.029) compared to first trimester] and IL-4 [in the 3rd trimester, (P=0.022) compared to second trimester] were observed different from what was observed among the HIV-negative women. Significant differences between HIV-positive and HIV-negative of IFN-γ [in the first trimester (P=0.013) and third trimester (P=0.021)], IL-4 [in the second trimester (P=0.017)] and IL-10 [in first trimester (P= 0.008), second trimester (P=0.019), and third trimester (P=0.009)] levels were observed. HIV-infected women demonstrated higher levels of IFN-γ, IL-10 and IL-4 cytokines with significant changes of IL-2, IL-6 and IL-4 and non-significant change of IL-10 compared the HIV-negative women. However inconsistent trends were observed in both groups. Based on these conclusions the present study thus recommends that IFN-γ, IL-10, IL-4 and IL-6 should be monitored alongside CD4 and CD8 cell counts during pregnancy among the HIV-infected women. Future research should focus and explore on the succinct roles of the other cytokines not considered in the present study among the HIV-infected pregnant women.