Abstract

PIP: Increased allogeneic activation may account for the observation that pregnancy induces worsening of HIV infection. Urinary neopterin levels were investigated in a 26-year-old woman who had a 10-year history of parenteral drug abuse and anti-HIV seropositivity. First seen at 16 weeks gestation, the patient presented without any AIDS-related signs or symptoms, but her urinary neopterin levels were highly elevated. The pregnancy was normal until week 31, when intrauterine death was diagnosed and delivery was induced. Urinary neopterin levels, elevated in almost all persons with HIV infection, were high throughout the pregnancy, with a mean value of 752 umol neopterin/mol creatinine. This level was almost double that of the 425 umol neopterin/mol creatinine level present before pregnancy. The neopterin level decreased to 500 umol following the delivery, and the patient remained free from AIDS-related symptoms for a further 10 months. The increased neopterin level is indicative of additional activation of the T cell/macrophage axis during pregnancy. Activation of the T cell axis represents the crucial event triggering progressive HIV expression. The neopterin levels found in this HIV-seropositive patient, in the range usually found in acute pulmonary tuberculosis, exemplify the higher degree of T cell activation in HIV seropositives during pregnancy. This could account for the worsening of HIV infection during pregnancy.