Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy

Suy, Anna; Martínez, Estebán; Coll, O.; Loncá, Montserrat; Palacio, M.; Lazzari, Elisa de; Larrousse, María; Milinkovic, Ana; Hernández, Sandra; Blanco, José Luis Santiago; Mallolas, Josép; León, Agathe; Vanrell, Juan A.; Gatell, José M.

doi:10.1097/01.aids.0000198090.70325.bd

Cited by 155 publications

(99 citation statements)

References 28 publications

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“…A previous study based on data from the third round of the National Family Health Survey in India has shown that the risk of spontaneous abortions and still births is higher among HIV infected women who were unaware about their HIV status, compared to HIV-negative women. 40 However, limited research is available on the effect of HAART on fetal death 41 and a recent pooled analysis of studies showed that HAART did not reduce the possibility of stillbirths. 42 In our study, in spite of the better CD4 counts at the time of pregnancy due to treatment (HAART), the group of women who received HAART might be clinically different than the women who received AZT.…”

Section: Darak Et Almentioning

confidence: 99%

Effect of Highly Active Antiretroviral Treatment (HAART) During Pregnancy on Pregnancy Outcomes: Experiences from a PMTCT Program in Western India

Darak

Darak²,

Kulkarni³

et al. 2013

AIDS Patient Care and STDs

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Section: Darak Et Almentioning

confidence: 99%

Effect of Highly Active Antiretroviral Treatment (HAART) During Pregnancy on Pregnancy Outcomes: Experiences from a PMTCT Program in Western India

Darak

Darak²,

Kulkarni³

et al. 2013

AIDS Patient Care and STDs

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“…This is in contrast to the recently reported study of Suy et al from Barcelona reporting a higher incidence of preeclampsia and fetal death in HIV-infected pregnant women in the HAART era compared with the general hospital population and a historical cohort of HIV-infected pregnant women from the pre-HAART era. 12 A comparison with the general population might well be misleading as HIV-infected women may constitute a subpopulation that is more at risk for adverse pregnancy outcome. Also in the present study the incidence of perinatal mortality in the HIV-infected women was high as compared with the general population, but not different from the matched control women.…”

Section: Commentmentioning

confidence: 99%

The AmRo study: pregnancy outcome in HIV‐1‐infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

Boer¹,

Nellen

Patel

et al. 2007

BJOG

116

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Objective To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART).Design Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n = 98).Setting Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands.Population Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women.Main outcome measures MTCT, preterm delivery, low birthweight, pre-eclampsia.Results MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P = 0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls.Conclusions We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAARTassociated increase in preterm delivery rate is mainly seen after first trimester HAART use.

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“…However, adverse pregnancy outcome have been increasingly reported by several observational studies in HIV‐infected women exposed to HAART 6, 7, 8, 9, 10, 11. Anti‐retrovirals and HIV‐infection have been associated with pre‐eclampsia, stillbirth, pre‐term labour, low birth weight and intrauterine growth restriction (IUGR) 12, 13, 14, 15, 16, 17.…”

Section: Introductionmentioning

confidence: 99%

Mitochondrial toxicity and caspase activation in HIV pregnant women

Hernández

Morén

Catalán-García

et al. 2016

J Cellular Molecular Medi

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To assess the impact of HIV‐infection and highly active anti‐retroviral treatment in mitochondria and apoptotic activation of caspases during pregnancy and their association with adverse perinatal outcome. Changes of mitochondrial parameters and apoptotic caspase activation in maternal peripheral blood mononuclear cells were compared at first trimester of pregnancy and delivery in 27 HIV‐infected and ‐treated pregnant women versus 24 uninfected pregnant controls. We correlated immunovirological, therapeutic and perinatal outcome with experimental findings: mitochondrial DNA (mtDNA) content, mitochondrial protein synthesis, mitochondrial function and apoptotic caspase activation. The HIV pregnancies showed increased adverse perinatal outcome (OR: 4.81 [1.14–20.16]; P < 0.05) and decreased mtDNA content (42.66 ± 5.94%, P < 0.01) compared to controls, even higher in naïve participants. This depletion caused a correlated decrease in mitochondrial protein synthesis (12.82 ± 5.73%, P < 0.01) and function (20.50 ± 10.14%, P < 0.001), not observed in controls. Along pregnancy, apoptotic caspase‐3 activation increased 63.64 ± 45.45% in controls (P < 0.001) and 100.00 ± 47.37% in HIV‐pregnancies (P < 0.001), in correlation with longer exposure to nucleoside analogues. HIV‐infected women showed increased obstetric problems and declined genetic and functional mitochondrial parameters during pregnancy, especially those firstly exposed to anti‐retrovirals. The apoptotic activation of caspases along pregnancy is emphasized in HIV pregnancies promoted by nucleoside analogues. However, we could not demonstrate direct mitochondrial or apoptotic implication in adverse obstetric outcome probably because of the reduced sample size.

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Increased risk of pre-eclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy

Abstract: HIV infection treated with HAART prior to pregnancy was associated with a significantly higher risk for pre-eclampsia and fetal death.

Cited by 155 publications

References 28 publications

Effect of Highly Active Antiretroviral Treatment (HAART) During Pregnancy on Pregnancy Outcomes: Experiences from a PMTCT Program in Western India

Effect of Highly Active Antiretroviral Treatment (HAART) During Pregnancy on Pregnancy Outcomes: Experiences from a PMTCT Program in Western India

The AmRo study: pregnancy outcome in HIV‐1‐infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

Mitochondrial toxicity and caspase activation in HIV pregnant women

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