Aspectos anatomoclínicos e laboratoriais de gestantes infectadas pelo HIV e expostas ao ZIKA vírus.

Abstract

The Zika vírus (ZIKV) epidemic that occurred in Brazil from 2015 was followed by the identification of complications, the most impotant being related to the congenital syndrome associated with ZIKV (SCZ). Placentas from pregnant women exposed to the vírus may exhibit variable morphological changes. Such changes can be modified in immunosuppressed patients, in the context of co-infecctin, and may be associated with different neonatal outcomes. Objective: Characterize the morphological aspects of placentas from HIV-infected pregnant women and compare with placenta from ZIKV carriers, and in ZIKV-HIV co-infection. Methods: Thirty-seven HIV-positive pregnant women who were being followed up at a referral obstetric service and who had suspected symptoms of arbovirus infection were included. Clinical data of pregnancy, anatomopathological analysis and research of viral genetic material of the placentas were performed and compared with the histology of placentas from perenant women who were know to have ZIKV infection during pregnancy and with a control group. Results: The most observed antiretroviral regimen was the combination of lamivudine (3TC) + tenofovir (TDF) + efavirenz (EFZ) – 37,4%. The mean viral load at delivery was 836 copies/ml, with a reduction of 81,9% compared to admission (p=0,019). The mean gestational age at birth, birth weight and Apgar score of newborns did not differ from the population. The macroscopic analysis showed an average weight of 423.5g and identifiction of fone case of old infarction, one of retroplacental and suchorionic hematoma, in addition to signs of umbilical cord thrombosis and change in the color of the placenta in 16.2% of cases. The main microscopic finding was marked distal villous hypoplasia present in 88.8% of the placentas of pregnant women with ZIKV and moderate distal villous hypoplasia presente in 62.1% of the placentas of pregnant women with HIV. Other findings indentified were corangiosis, congestion and thickening of villous vessels. HIV genetic material was identified in 94,5% of the placentas in the group of patients with HIV and in 10.8% of these placentas the co-infection by ZIKV was also identified. No marked distal villous hypoplasia was identified in the ZIKV-HIV co-infection group. HIV and ZIKV viruses independently compromise the human placenta and, when associated, there is evidence of reduced impact of ZIKV.