HIV Infection in Pregnancy and the Risk of Gestational Hypertension and Preeclampsia

Abstract

The objective of this study was to evaluate the association between HIV infection and hypertensive disorders of pregnancy, comparing the rates of preeclampsia and gestational hypertension in a HIV-infected pregnant group and in a HIV-negative control pregnant group matched for age and parity. Furthermore, we aimed to compare the rates of hypertensive disorders in a subgroup of HIV-positive and HIV-negative African-American Black women. Patients and Methods: This was a prospective observational cohort study conducted at two University Departments of Obstetrics and Gynecology, Salesi Hospital, Ancona, and Sant'Orsola Hospital, Bologna. The HIV-infected patients' group consisted of 126 pregnant women; 140 HIV-negative pregnant women matched for age and parity served as controls. Gestational hypertension and preeclampsia were diagnosed according to NHBPEP-ISSHP criteria. Categorical data were analyzed using the Fisher exact test. Statistical significance was set at a p value < 0.05. Results: Gestational hypertension and preeclampsia were diagnosed in 3 of 126 HIV-positive patients (2.38%) and in 14 of 140 HIV-negative patients (10%), with a relative risk of 0.24 (p = 0.0112). In the subgroup of African-American Black women, gestational hypertension and preeclampsia were diagnosed in 2 out of 43 HIV-positive (4.7%) and in 3 out of 18 HIV-negative patients (16.7%) with a relative risk of 0.28, not statistically significant (p = 0.1887). Conclusion: Pregnant women with HIV infection seem to be protected against gestational hypertension and preeclampsia and this protective effect remains also in a high risk population, such as African-American Black ethnic group. The effect is present independently from treatment received and virus copies. The lack of immune response present since the conception period should account for unopposed trophoblast invasion resulting in a better placentation. B. Landi et al. 258

The Involvement of MicroRNAs in SARS-CoV-2 Infection Comorbid with HIV-Associated Preeclampsia

“…Maternal deaths from HIV infection is high (>34%) in SA followed by obstetric haemorrhage and HDP [15]. Several studies have postulated that HIV infection influences the rate of PE development [27][28][29][30][31].…”

Combined antiretroviral therapy for HIV and the risk of hypertensive disorders of pregnancy: A systematic review

“…In contrast, seven studies (7/19, 36.8%) demonstrated no difference in rates of HDP between pregnant WLHIV using cART and seronegative women (7,8,22,24,28,31,36). However, three studies (3/19, 15.8%) specifically demonstrated a statistically significant decreased frequency of HDP among pregnant WLHIV using cART, when compared with seronegative women (9,21,37). For example, Hall et al note that the odds of developing preeclampsia or gestational hypertension are lower among pregnant WLHIV using cART (aOR 0.44, 95% CI 0.29-0.66) compared to women without HIV (9).…”

“…The remainder of cohort studies offered a matched, HIV-uninfected comparison group (n=11, 68.9%), while one study created a seronegative control group additionally matched for age and parity. (21) No studies matched for CD4 count.…”

The Role of Highly Active Antiretroviral Therapy (HAART) on Interleukin 17A (IL-17A) in Normotensive and Preeclamptic Black South African Women

“…HAART is the current recommended treatment for HIV infection. The current recommended treatment for HIV infection in pregnant and nonpregnant women is HAART [24]. The use of HAART in pregnancy is important for the reduction of perinatal transmission by several mechanisms, including lowering maternal antepartum viral load and preexposure and postexposure prophylaxis of the infant [25].…”