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Training Years: 2018-2019

Training Site: University of Zambia (UNZA)

Country: Zambia

Mentors: Jeffrey Stringer, MD; Bellington Vwalika, MD

Title: Effects of antiretroviral therapy initiation and progesterone supplementation on circulating angiogenic markers and vaginal inflammation in HIV-infected pregnant women

Project Objectives: HIV-infected women have an elevated risk of preterm birth (PTB). This risk may be further increased by antiretroviral therapy (ART), especially if drugs are started prior to conception. Whether this phenomenon is the result of placental vascular dysfunction, local or systemic inflammatory processes, or other causes is unknown. This application will leverage infrastructure and specimen collection in two ongoing randomized trials of antenatal progesterone to prevent HIV-related PTB in Lusaka, Zambia.

Aim 1: to compare levels of circulating angiogenic factors between HIV-infected women who initiate ART prior to conception and those who initiate ART during pregnancy. Our hypothesis is that preconceptional ART will be associated with an anti-angiogenic state (as expressed by altered levels of PIGF, sFlt-1, and sEng in the peripheral circulation) when compared to women initiating ART in pregnancy.

Aim 2: to compare levels of vaginal inflammatory cytokines between women randomized to progesterone supplementation versus those randomized to placebo in an ongoing trial. Our hypothesis is that exposure to vaginal progesterone will be associated with lower levels of vaginal inflammation (as expressed by IL-6, IL-8, IL-1β, SLPI).

NIH Support: Fogarty fellowship postdoctoral training award

Megan Smithmyer Headshot