Dynamics of Cytokines and Chemokines During the Peripartum Period in People Living With Human Immunodeficiency Virus.

PROBLEM: Pregnancy requires a precisely regulated immune response to support fetal development and minimize complications. Human immunodeficiency virus (HIV) infection induces a chronic inflammatory state and is associated with adverse pregnancy outcomes. In this observational cohort of pregnant people living with HIV in the Democratic Republic of the Congo (DRC), we sought to gain a deeper understanding of peripartum changes in cytokines, chemokines and soluble factors (collectively termed immune factors). METHOD OF STUDY: Pregnant individuals living with HIV were enrolled during their second or third trimester in Kinshasa, DRC, between October 2020 and May 2021. Peripheral blood samples were collected at: enrollment (second or third trimester), 1-3 days postdelivery and postpartum. Concentrations of 45 immune factors were measured using LegendPlex and ELISAs. RESULTS: Most chemokines decreased significantly from enrollment to postdelivery, followed by a rebound in the postpartum period. Meanwhile, concentrations of myoglobin, serum amyloid A-1 protein (SAA), and interleukin 6 (IL-6), increased from enrollment to postdelivery, followed by a decrease postpartum. Finally, protein S100-A8/protein S100-A9 (S100A8/A9) and insulin-like growth factor-binding protein 4 (IGFBP4) consistently increased from enrollment through postpartum. CONCLUSIONS: The postdelivery decline in chemokines observed in this study has not previously been reported. This shift may result from two mechanisms: greater-than-expected placental chemokine production or the degradation of key signaling molecules during parturition and early uterine involution. Additionally, the rise in proinflammatory markers from enrollment to postdelivery suggests a persistent inflammatory state, either unaffected by fetal delivery or worsened by tissue damage in the gestational parent.