Alex is working with Borne Founder Professor Mark Johnson and Dr Nesrina Imami, combining their expertise to research how HIV infection affects the way the immune system functions during pregnancy. Today, on World AIDS Day, Alex tells us more about his research into HIV and preterm birth and what the day means to him.

“What do you do here at Borne?”

As a scientist for Borne, my work has me going all over the hospital, recruiting women from the antenatal clinic, HIV clinic and labour ward for our research. After obtaining their blood, I look at how their white blood cells, the immune cells, change as pregnancy develops. In the lab, I assess changes in different immune cell subsets, and how these cells respond to different viruses that are associated with preterm labour and other pregnancy complications.

“How does HIV affect preterm birth?”

This is such an important question and the short answer is that we do not know exactly. There are many immune mechanisms that are involved in supporting pregnancy to full term birth, protecting the growing foetus from the mother’s own immune cells and from possible pathogens. HIV disrupts the immune system, and without treatment, will develop to acquired immunodeficiency syndrome (AIDS).

In both developed and resource poor countries the rate of preterm birth in HIV positive pregnancies is roughly double that of HIV negative ones. Understanding how the virus alters the immune system through pregnancy will not only inform HIV pregnancy care, but will identify components of the immune system that potentially influence preterm labour.

“Why did you choose to study the immune system in pregnancy?”

I find the immune system fascinating. It can protect you from millions of pathogens, it has memory that we can take advantage of with vaccines and it also has the subtlety to tolerate a foetus instead of trying to reject it. The complexity of it is staggering, and while our understanding of it grows we still have much to understand to be able to manipulate it to promote the healthiest pregnancy possible.

“What’s the most interesting thing you have learnt from your research so far?”

One of the most interesting things is the difference I’ve seen between the balance of pro-inflammatory (up-regulating) and regulatory (down-regulating) responses of immune cells in the HIV positive and negative groups. It is evidence that the immune system of these women with HIV is reacting in a different way to those without. However, whether this is showing that the system is unbalanced, or that it is trying to compensate against the virus, is still to be determined.

“What is the long-term goal in researching the interaction between HIV and preterm birth – why is it so important?”

The goal of looking at HIV and preterm birth together is to better understand the role the different components of the immune system play. The fact that the rate of preterm birth is higher in HIV positive women indicates there is a change in their immune system that causes this. By looking for these differences not only can we hopefully identify what is changing, but how this impacts pregnancy and preterm birth risk, and how to go about treating it. Considering the increase in preterm birth rates globally, this is extremely important.

“Today is World AIDS Day, what does it mean to you?”

For me it is a day to promote awareness. In the UK, we have great access to antiretroviral therapy that can control HIV and can allow individuals infected with the virus to live normal lives. However, stigma and fear of HIV still very much cloud people’s ideas of what living with HIV is like. Misinformation about how the virus can be transmitted, lack of knowledge of how HIV treatment has developed and social stigma all have an impact.

World AIDS day is important to spread awareness and knowledge of HIV, but also to remember that HIV has a worldwide impact. There are over 37 million people living with HIV. The more awareness and education there is, the better chance we have of reducing this number.