Purpose of the review: This review highlights the role of angiogenesis, lymphangiogenesis, and immune markers in human immunodeficiency virus (HIV)-associated preeclamptic (PE) pregnancies in an attempt to unravel the mysteries underlying the duality of both conditions in South Africa. Recent findings: Studies demonstrate that HIV-infected pregnant women develop PE at a lower frequency than uninfected women. In contrast, women receiving highly active anti-retroviral therapy (HAART) are more inclined to develop PE, stemming from an imbalance of angiogenesis, lymphangiogenesis, and immune response. Summary: In view of the paradoxical effect of HIV infection on PE development, this study examines angiogenesis, lymphangiogenesis, and immune markers in the highly HIV endemic area of KwaZulu-Natal. We believe that HAART re-constitutes the immune response in PE, thereby predisposing women to PE development. This susceptibility is due to an imbalance in the angiogenic/lymphangiogenic/immune response as compared to normotensive pregnant women. Further large-scale studies are urgently required to investigate the effect of the duration of HAART on PE development.

Background/aim: Impaired lymphatic function is associated with pathological conditions. The presence of placental lymphatics is still under debate. This study evaluates the placental podoplanin expression in normotensive and preeclamptic women with and without HIV. Materials and methods: Normotensive (n = 60) and preeclamptic (n = 120) pregnant women were stratified into early and late onset preeclampsia and further divided by HIV status. lmmunostaining was performed using the podoplanin antibody prior to the morphometric image analysis. Results: Podoplanin was hnmunolocalized in a reticular-like stroma complex within the exchange and conducting villi. The immunoexpression of podoplanin was significantly upregulated in the exchange villi (P = 0.001) irrespective of the pregnancy type and HIV status. Based on pregnancy type, podoplanin was downregulated in early onset preeclampsia (15.33 +/- 4.27%) compared to late onset preeclampsia in the exchange villi (17.85 +/- 4.74%; P = 0.04). Podoplanin was upregulated in HIV+ vs. HIV-cases regardless of pregnancy and villi type. Irrespective of pregnancy type, podoplanin immunoexpression within exchange villi was different (P = 0.008) between the HIV+ and HIV-groups. Conclusion: Placental fluid homeostasis is maintained by a podoplanin reticular-like complex within conducting and exchange villi, being upregulated in HIV-positive pregnancies.

Background: Despite the availability of screening guidelines and effective treatment for maternal syphilis (MS), its prevalence remains high and is re-emerging in many parts of the world. This might be because of varying screening tests and algorithms for the laboratory diagnosis and treatment of syphilis. In addition, HIV co-infection may compromise the elimination of MS. The present study is a clinical audit of the prevalence of MS in KwaZulu-Natal, South Africa, using the ‘Traditional Algorithm’ screening. Methods: This was a retrospective audit in which data on syphilis testing were obtained over a 1-year period (2016) at a large regional hospital in South Africa. The standard screening test at the study site was the non-treponemal antigen, rapid plasma reagin (RPR). Data on the prevalence of MS and comorbidity with HIV infection were analysed. Results: There were 10 680 deliveries in the study period of which 118 were RPR reactive, giving an MS prevalence of 1.1%. MS occurred predominantly in the age groups < 18 and > 35 years (p = 0.001). The prevalence of HIV infection was 41.2% (n = 4451). Seventy-two (61.0%) had both HIV and MS infection, whilst 46 (39.0%) had discordant results (p = 0.001). Conclusion: We report an increase in the prevalence of MS compared to previous South African National Antenatal Syphilis Surveillance studies. This may be because of the prozone effect caused by HIV infection on the sensitivity of the RPR. We propose a change in MS screening, using a Rapid DUO (Dual HIV and syphilis point of care test) and Reverse Algorithm for screening that could improve the sensitivity, detection and management of both diseases.

Tive study was conducted at a regional hospital in Durban, South Africa during 14 months. A total of 14304 deliveries were registered. Out of the 1759 preeclampsia, 351 (19.9%) were EOPE and 1408 (80.1%) were LOPE. Hundred and twenty preeclamptics (n = 120) scheduled for caesarean delivery were selected and divided into two categories namely EOPE (n = 60) and LOPE (n = 60). Each preeclampsia category was then further stratified into HIV positive (n = 30) and HIV negative (n = 30) groups. Maternal demographic, clinical details for preeclampsia, blood laboratory tests, maternal, and perinatal outcomes were recorded. Results: Women with EOPE were older compared to those with LOPE (P = 0.0001). Also the HIV positive women were older compared to the HIV negative groups in both EOPE and LOPE categories (P = 0.03). However, multiparous and primiparous were predominant in EOPE and LOPE categories, respectively (P = 0.00 and P = 0.00). The severity of hypertension and the HIV status did not differentiate the 2 groups. Overall, maternal complications (eclampsia, persistent postpartum hypertension, HELLP syndrome, maternal death) and poor fetal outcomes occurred predominately in EOPE. Conclusion: This study confirms the heterogeneity of preeclampsia and shows that the timing of onset of this pregnancy disorder is important to disease severity. Further HIV status influences maternal and neonatal outcome....

Background. Syphilis is a sexually transmitted infection that is most frequently found in lower socio-economic groups globally and is associated with significant maternal and fetal complications. In South Africa (SA), the last two to three decades have seen a rise in the number of people in the low and middle economic social groups seeking private specialist healthcare services. Objective. To evaluate the prevalence rates of maternal and congenital syphilis in a private specialist healthcare setting. Methods. The laboratory case records of women who had antenatal maternal syphilis (MS) screening using the automated chemiluminescence immunoassay (Architect Syphilis TP) in a private laboratory facility in Durban were reviewed. Results. A total of 9 740 individual maternal serum samples were analysed and 256 were Architect Syphilis TP positive, resulting in a MS prevalence rate of 2.7%. Of the less than three-quarters of exposed neonates tested (71.1%; n=182/256), 38.5% (n=70/182) were Architect syphilis TP positive. Less than a tenth of exposed neonates (2.43%; n=6) had only rapid plasma reagin (RPR) titers test whereas 26.6% (n=68/256) did not have a syphilis screen test. Based on the 182 exposed neonates tested, the congenital syphilis (CS) prevalence from the laboratory records was 7.7%. The highest rate of MS was in the ≥35 years age group. Conclusion. The prevalence of MS in the private specialist healthcare sector in SA is relatively high and warrants continued maternal antenatal screening during early pregnancy across all socio-economic groups. The high rate of MS in the age group over 35 years warrants further investigations and explanation.

The role of angiogenesis in preeclampsia pathogenesis is widely studied; however, despite the lymphatic vessels’ complementary role to the blood vascular system, studies on their morphology in the placenta and placental bed are lacking. In total, 87 placental bed specimens were utilized, which were grouped into normotensive pregnant ( n = 28), early-onset preeclampsia ( n = 31), and late-onset preeclampsia ( n = 28), and further stratified by human immunodeficiency virus (HIV) status. Tissue was immunostained with podoplanin antibody to investigate whether HIV infection affects lymphangiogenesis. The lymphatic capillary density and luminal areas within the placental bed were morphometrically assessed. Lymphatic microvessel density and mean area/lumen in the preeclampsia group were higher and larger than in the normotensive group, respectively ( p = 0.01 and p = 0.001). A correlation between blood pressure levels and lymphatic microvessel density was observed ( r ≥ 0.272; p ≤ 0.032). Significant differences were observed between the mean microvessel density of normotensive HIV-uninfected and HIV-infected groups (5.9 ± 2.3 versus 7.5 ± 2.8, p = 0.01) and late-onset preeclampsia HIV-uninfected and HIV-infected groups (7.1 ± 3.9 versus 7.8 ± 2.7, p = 0.01). The mean area/lumen between normotensive HIV-uninfected and HIV-infected, and late-onset preeclampsia HIV-uninfected and HIV-infected groups were significantly different ( p = 0.03 and p = 0.001). Small lymphatic capillaries were significantly abundant in late-onset preeclampsia HIV-infected ( p = 0.03) and normotensive HIV-infected ( p = 0.0001) groups compared with uninfected groups. Lymphatic capillary density and area/lumen upregulation was observed in the placental bed of HIV-infected women, with a positive correlation between maternal blood pressure and lymphatic microvessel density, potentially affecting birth weight in the preeclampsia group.