Early spontaneous abortions and fetal thymic abnormalities in maternal‐to‐fetal HIV infection

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Abstract
The thymus is thought to play a major role in the immunopathogenesis of human immunodeficiency virus (HIV) infection, particularly in maternal‐to‐fetal HIV transmission. Characteristic lesions of the HIV‐infected thymus include a prominent CD4+ CD8+ T lymphocyte depletion at the corticomedullary junction, the region of the thymus where immune selection occurs. At least threefold excess early spontaneous abortions were noted in a cohort of 124 HIV‐infected pregnant women. In these 13 abortuses a very high rate (54%) of HIV vertical transmission was documented, with the thymus gland particularly affected. It is possible that the thymic insult in HIV‐infected fetuses contributes to immune rejection of the fetus, possibly by an imbalance of maternal and fetal T1‐ and T2‐type cytokines, known to be important in HIV disease progression. We propose, therefore, that the early spontaneous abortions occurring in HIV‐infected pregnant women are due, at least in part, to abnormal immune forces created by HIV infection of the thymus.