AIMS: To show the presence of HIV infected cells in the placentas and membranes exposed to HIV during pregnancy, and to trace the possible transmission routes from mother to fetus. METHODS: Twenty three therapeutic abortions and 11 term placentas were investigated for the presence of HIV antigen by immunostaining with HIV core protein specific antibodies and HIV nucleic acids by in situ hydridisation (ISH) with a 35S-labelled HIV specific RNA probe. RESULTS: HIV antigen as well as HIV RNA positive cells were rarely found in placental tissue and membranes. In therapeutic abortions HIV antigen was shown in 10 out of 23 placentas, HIV RNA in two. HIV antigen was detected in five out of 11 term placentas and HIV RNA in two. Infected cell types comprised syncytiotrophoblasts, Hofbauer cells, amnionic epithelium, chorionic macrophages as well as maternal lymphocytes in the intervillous space and decidua. CONCLUSION: These data suggest that the transmission routes are: (1) a haematogenous route from the maternal intervillous space to villous stromal cells; (2) from chorion laeve to amnionic fluid and vice versa. Two additional transmission routes are partly suggested by the data: (1) in early gestation by direct extension from basal decidua to budding trophoblastic cells; (2) from the capsular decidua to chorion laeve and chorionic plate, entering the fetal circulation via the small veins.
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