# HIV immune environment impact on pre-eclampsia

> **NIH NIH R03** · NORTHWESTERN UNIVERSITY · 2023 · $80,000

## Abstract

PROJECT SUMMARY/ABSTRACT
Pre-eclampsia (PE) is a leading cause of maternal and fetal morbidity and mortality. It is a placental-driven
disease characterized by alterations in placental development and placental perfusion that lead to the clinical
stage of placental oxidative stress, hypertension and proteinuria. The exact etiology of PE is still unknown.
However, a growing body of evidence suggests that immune imbalances during placentation may drive the
development of the disease. In particular, PE seems to be characterized by a lack of Th1/Th2 switch early after
conception and an altered immune and angiogenic environment with higher levels of inflammatory markers and
lower levels of tolerogenic markers. Moreover, impaired phenotype and function of decidual NK cells, which play
a critical role in placentation, are probably involved interfering with correct trophoblast invasion. HIV infection in
untreated pregnant women appears to drive lower rates of PE development. This may be due to HIV-driven
immune suppression. However, HIV infected women treated with combination antiretroviral therapy (cART) may
be at higher risk of PE than untreated women or uninfected controls. The exact impact of cART on the
development of PE is still unclear. However, studies that distinguish cART at conception from cART started
during the 2nd or 3rd trimester report higher incidence of PE in women treated with cART at conception. Herein
we will test the hypothesis that immune imbalances in HIV infected pregnant women treated with cART at
conception predispose to the development of PE. We will test our hypothesis investigating samples collected
from a large, concluded IMPAACT study, P1025. The P1025 study samples will allow for the comparison of 2nd
and early 3rd trimester women on cART at conception with HIV infected women who started cART during the 2nd
trimester. Our two specific aims focus on: SA1) determining the association of cART at conception with known
angiogenic and inflammatory markers of PE and, SA2) investigating if and how immune cell markers on T cell
and NK cell subsets correlate with angiogenic markers that are known to predict the development of PE in women
on cART at conception. In conclusion, we are addressing a critical problem in maternal health in HIV infected
women that could help to identify and test new strategies to reduce the development of PE in cART-treated HIV
infected pregnant women.

## Key facts

- **NIH application ID:** 10629367
- **Project number:** 5R03AI170156-02
- **Recipient organization:** NORTHWESTERN UNIVERSITY
- **Principal Investigator:** Elena Martinelli
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $80,000
- **Award type:** 5
- **Project period:** 2022-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10629367

## Citation

> US National Institutes of Health, RePORTER application 10629367, HIV immune environment impact on pre-eclampsia (5R03AI170156-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10629367. Licensed CC0.

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