PHDS EXPLORE MATERNAL AND CHILD HEALTH IN RELATION TO HIV

PHDS EXPLORE MATERNAL AND CHILD HEALTH IN RELATION TO HIV

UKZN’s Optics and Imaging Centre (OIC) produced three PhDs last year that make a significant contribution to understanding maternal and child health in relation to HIV.

According to Professor Anita Naicker, pre-eclampsia, a hypertension disorder in pregnancy, is the second highest cause of mortality for pregnant women after HIV. She said the prevalence of pre-eclampsia in African women is very high – at 14 percent in South African women, and at 5 percent for pregnant women globally.

‘Pregnant women who suffer from the condition experience high blood pressure and lose protein in their urine. This can affect both the mother and the baby,’ she said.

Naicker supervised two studies that focused on pre-eclampsia and HIV. They were conducted by Dr Firoza Haffejee and Dr Nalini Govender, both Lecturers at the Durban University of Technology.

Haffejee’s PhD looked at leptin – the protein hormone that plays a key role in regulating energy intake and energy expenditure which is also produced by the placenta during pregnancy. It demonstrated elevated placental leptin in pre-eclampsia, irrespective of HIV status, and this elevation was not reflected in maternal serum, suggestive of an autocrine role of leptin in the placenta. The study concluded that irrespective of HIV status, leptin is involved in the causation of pre-eclampsia.

Naicker said pre-eclampsia is a condition in which it is known that the baby receives insufficient blood supply. ‘Surely, there is a response to form new blood vessels ... this was the speculation from which Dr Nalini Govender’s PhD thesis emanated,’ said Naicker.

Govender’s PhD was a novel study conducted in an attempt to elucidate whether a paradigm shift in the balance of proangiogenic (VEGF & PlGF)  and antiangiogenic (sFlt-1 and sEng) factors exist in normotensive and pre-eclamptic pregnancies compromised by HIV infection.

She said that in a compromised immune system such as HIV infection, there may be an exacerbation of events relating to serious pregnancy conditions such as recurrent miscarriages, pre-eclampsia, diabetes and preterm labour. The study found that whether the pregnancy is complicated by immune insufficiencies or not, this does not affect the role of the antiangiogenic factors in pre-eclampsia development.

‘The serum reduction of sFlt1 and sEng within the HIV-positive cohorts advocates a neutralisation of the immune hyperreactivity of pre-eclampsia. Nevertheless, the neutralising effect of HIV infection on the immune system may be insufficient in the development of pre-eclampsia. Whilst the endothelial dysfunction that characterises pre-eclampsia still maintains a pivotal role in its etiology, there may be alternative mechanisms by which these antiangiogenic factors operate.’

The third study was conducted by Dr Duran Ramsuran who is currently pursuing postdoctoral research at the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH).

Ramsuran’s study outlines the spectrum of paediatric nephropathy in children in KwaZulu-Natal. It demonstrates podocyte phenotype dysregulation pre-HAART and reconstitution post therapy. Evidence of ultrastructural viral reservoirs within epithelial cells is supported by a genetic appraisal confirming the ubiquitous presence of HIV DNA in renal tissue. Moreover, sequence analysis showed viral evolution and compartmentalisation between renal viral reservoirs to blood. 

The trio graduated on 18 April, and Naicker said that these studies contributed significantly to their development as medical scientists, apart from their academic contribution.

author email : memelal@ukzn.ac.za