Histopathological features in advanced abdominal pregnancies co-infected with SARS-CoV-2 and HIV-1 infections: A case evaluation

OBJECTIVES: This study aims to provide a semi-qualitative histopathological report of the dual SARS-CoV-2 and HIV infected placentae in the third trimester of Advanced Abdominal Pregnancy (AAP). STUDY DESIGN: Four AAP placentae in the third trimester of pregnancy (two positive for HIV-1 and two positives for SARS-CoV-2) were histologically examined. RESULTS: The SARS-CoV-2(+) HIV(+) placentae were dysmorphic in shape compared to the flattened disc-like shape noted in the SARS-CoV-2(+)HIV(-), SARS-CoV-2(-)HIV(+)and SARS-CoV-2(-)HIV(-) placentae. Diffused syncytial knots and syncytial degeneration were observed in all placentae. Intermittent cytotrophoblast increase, perivillous and intravillous fibrin deposition, mononuclear inflammatory cells with widespread degeneration/necrosis of the syncytiotrophoblast and microcalcification were pronounced in the SARS-CoV-2(+)HIV(+) compared to the SARS-CoV-2(+)HIV(-) placentae. Vascular pathological changes included thrombi, ectasis, mural hypertrophy and atherotic vessels. CONCLUSION: Elevated syncytial trophoblast injury, villitis, microcalcifications and mineralisation of the syncytial basement membrane in the AAP placentae may be due to SARS-CoV-2 viral transgression instead of HIV infection alone. Vascular malperfusion is suggestive of a hypoxic insult arising from a compensatory response to meet the fetal oxygen and nutrient demands of an AAP. Placentae from HIV infected women on antiretroviral treatment were characterised by vascular malperfusion.