Pre-eclampsia, antiretroviral therapy, and immune reconstitution

Wimalasundera, R.; Larbalestier, N; Smith, JH; Ruiter, Annemiek de; Thom, S; Hughes, Alun D.; Poulter, NR; Regan, Lesley; Taylor, G. P.

doi:10.1016/s0140-6736(02)11195-0

Cited by 154 publications

(121 citation statements)

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“…Wimalasundera et al [54] found a lower rate of PE among untreated HIV-infected women when compared to uninfected women or HIV-infected on treatment. Several studies show no difference in the rates of PE between HIV-uninfected and HIV-infected women treated with HAART [55,56] or even a lower rate of PE among HIVinfected treated when compared to uninfected women [57]. The use of HAART at conception was a risk factor for PE/E.…”

Section: Discussionmentioning

confidence: 98%

Possible Changes in Maternal Plasma Cortisol, AdrenocorticotropicHormones, Pregnancy Associated Plasma Protein-A and Alpha-fetoproteinin HIV Pregnant Women at NAUTH Nnewi, Nigeria

Ukibe¹,

Onyenekwe²,

Anojulu³

et al. 2015

J Bioanal Biomed

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Background: There is limited information on if HIV infection induces stress in pregnancy. HIV can possibly contribute to the alterations in some fetal viability hormones thereby lead to adverse pregnancy outcome. The present study aimed to assess the possible changes in maternal cortisol, Adrenocorticotropic (ACTH), Pregnancy associated plasma protein-A (PAPP-A) and alpha-fetoprotein (AFP) hormone concentrations in HIV-infected pregnant women and their pregnancy outcomes. Methods:A cross sectional study of 80 (Eighty) volunteer pregnant women aged (18-49) years recruited during routine antenatal clinics in Nnamdi Azikiwe Teaching Hospital, Nnewi, Anambra State, Nigeria was conducted. The participants were divided into groups: 40 (forty) apparently healthy pregnant and 40 (forty) HIV-infected pregnant women. 5 ml of morning blood samples were collected from each subject in their 1 st and 2 nd trimesters for estimation of Cortisol, ACTH, AFP and PAPP-A using ELISA method. Results:The result showed that the mean systolic and diastolic blood pressures (mmHg) of HIV pregnant women were significantly higher than control (p<0.05 respectively). The mean value of cortisol (ng/ml) in HIV pregnant women was significantly higher when compared with control subjects (p<0.05). Cortisol showed inverse significant correlation with AFP in HIV-infected pregnant women. Maternal outcomes showed thatt HIV-infected pregnant women had significantly higher incidence of miscarriages and preeclampsia with higher incidence of perinatal outcomes such as low birth weight babies (LBW), preterm delivery, spontaneous abortion, still birth and low Apgar scores when compared with apparently normal pregnant women (P<0.05 respectively).Conclusion: the significantly higher cortisol level and BP in HIV pregnant women is indicative of oxidative stress due to perceived stress by HIV infection which might predispose the affected women to hypertension and preeclampsia. The highest adverse reactions observed in HIV pregnant women might be related to the damaged immune system by HIV infection however, the placental defect associated with increased placental permeability to AFP and the activity of the insulin-like growth factor (IGF) system is not related to the activity of stress thereby do not influence their birth outcomes.

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Section: Discussionmentioning

confidence: 98%

Possible Changes in Maternal Plasma Cortisol, AdrenocorticotropicHormones, Pregnancy Associated Plasma Protein-A and Alpha-fetoproteinin HIV Pregnant Women at NAUTH Nnewi, Nigeria

Ukibe¹,

Onyenekwe²,

Anojulu³

et al. 2015

J Bioanal Biomed

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“…Причем, более низкая частота тяжелых форм гестоза отмечена у ВИЧ-инфици-рованных беременных, не получавших арВТ, чем у женщин с трехкомпонентной терапией. авторы связывают это с тем, что побочные действия пре-паратов, входящих в арВТ, совпадают с сим-птомами гестоза и могут быть причиной гипер-диагностики гестоза [21]. согласно полученным в настоящем исследовании результатам гестоз легкой и средней тяжести наблюдался у каждой четвертой беременной (27,5 %).…”

Section: Discussionunclassified

Clinical characteristics and obstetrical principals at HIV-infected women in Saint Petersburg

et al. 2014

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ВведениеПо оценочным данным, к концу 2012 года в мире насчитывалось 32-38 млн людей, жи-вущих с вирусом иммунодефицита человека (ВИЧ), среди которых женщины составляют более 40 % [2]. По официальным данным, на ко-нец 2013 г. кумулятивное число больных ВИЧ-инфекцией в российской Федерации составляет более 798 тысяч человек. За последние 5 лет отмечается ежегодное увеличение числа вновь выявленных случаев ВИЧ-инфекции. К концу 2012 г. среди людей, живущих с ВИЧ/сПИдом, женщины составили 36,7 %, среди которых 60 % находятся в репродуктивном возрасте [9]. рост числа случаев ВИЧ-инфекции у женщин преимущественно детородного возраста, воз-растающее значение гетеросексуального пути передачи ВИЧ способствуют увеличению числа ВИЧ-инфицированных женщин среди беремен-ных в общей популяции [8].санкт-Петербург по уровню пораженности ВИЧ-инфекцией является одним из лидирующих регионов российской Федерации. В эпидемию ВИЧ-инфекции за все года наблюдения было во-влечено более 55 тыс. человек, в том числе более 44 тыс. жителей санкт-Петербурга. Наблюдается стойкая многолетняя тенденция увеличения доли женщин среди впервые выявленных ВИЧ-инфи-цированных больных: с 25 % в 2001 г. до 41,5 % в 2012 г. Впервые в российской Федерации именно в санкт-Петербурге была создана специализиро-ванная служба, направленная на оказание акушер-ской помощи ВИЧ-инфицированным женщинам. Более 20 лет в структуре сПб ГБУЗ «Клиническая инфекционная больница им. с. П. Боткина» (КИБ им. с. П. Боткина) функционирует ин-фекционно-акушерское отделение, оказываю-щее комплексную специализированную помощь ВИЧ-инфицированным матерям и новорожден-ным. ежегодно в нем получают помощь 75,6 %

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“…In HIV-positive women on no antiretroviral treatment, one study reported that the rate of PE was decreased [4] and another study reported no significant difference compared …”

Section: Discussionmentioning

confidence: 99%

“…There is controversy over whether HIV infection and/or its treatment has an adverse effect on placentation and the incidence of pre-eclampsia (PE) [4][5][6][7][8]. The accepted model for the development of PE is based on an underperfused, hypoxic placenta which releases a pre-eclamptic factor(s), which in turn attacks the maternal endothelium, causing endothelial dysfunction and the clinical signs of PE [9].…”

Section: Introductionmentioning

confidence: 99%

First trimester maternal uterine artery Doppler examination in HIV-positive women

et al. 2011

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The aim of the current study was to assess the effect of maternal HIV infection, treated or untreated, on the degree of placental invasion, as assessed by the pulsatility index of the uterine arteries during a Doppler examination at 11 1 0 -13 1 6 weeks' gestation. MethodsThis was a nested case-control study in which a uterine artery Doppler examination was performed in the first trimester in 76 HIV-positive women. Each woman was matched with 30 HIV-negative women. As the pulsatility index of the uterine arteries depends on a number of maternal and fetal characteristics, its values in each case and control were expressed as multiples of the median (MoM) of the unaffected group. ResultsAmong the 76 HIV-positive women, 33 (43.4%) were on antiretroviral treatment at the time of the Doppler examination, including 14 women (42.4%) on nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor, 18 women (54.5%) on NRTIs and a nonnucleoside reverse transcriptase inhibitor and one woman (3.1%) on monotherapy. Compared with the HIV-negative women, the HIV-positive women were more likely to be heavier (Po0.01), to be of African origin (Po0.01), to be nonsmokers (P 5 0.01) and to deliver smaller neonates earlier (Po0.01). The median adjusted pulsatility index of the uterine arteries was not statistically different between the cases and controls [1.07; interquartile range (IQR) 0.85-1.24 MoM vs. 0.99; IQR 0.81-1.20 MoM; P = 0.28] or, in HIV-positive women, between those receiving and not receiving antiretroviral treatment (P 5 0.12). ConclusionsHIV-positive women with uncomplicated pregnancies have normal placental perfusion in the first trimester of pregnancy.Keywords: Doppler examination, HIV, pregnancy, uterine artery Accepted 1 March 2011 IntroductionThe increased incidence of HIV infection globally, the introduction of routine antenatal screening for HIV and the use of highly active antiretroviral therapy (HAART) in pregnancy have resulted in an increase in the number of pregnant women who are living with HIV. In the United Kingdom, it has been estimated that the prevalence of HIV infection in pregnancy is about 2.8 per 1000 women [1-3].There is controversy over whether HIV infection and/or its treatment has an adverse effect on placentation and the incidence of pre-eclampsia (PE) [4][5][6][7][8]. The accepted model for the development of PE is based on an underperfused, hypoxic placenta which releases a pre-eclamptic factor(s), which in turn attacks the maternal endothelium, causing endothelial dysfunction and the clinical signs of PE [9]. The uteroplacental vascular adaptation to supply the fetoplacental unit is dependent on invasion of the spiral arteries by the trophoblast and their conversion from narrow high-resistance vessels to dilated low-resistance channels. Studies assessing the uteroplacental circulation by Doppler ultrasound have reported that, in pregnancies DOI: 10.1111/j.1468-1293.00930.x HIV Medicine (2011 r 2011 British HIV Association 632 in which PE develops, there is an increased...

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Pre-eclampsia, antiretroviral therapy, and immune reconstitution

Cited by 154 publications

References 4 publications

Possible Changes in Maternal Plasma Cortisol, AdrenocorticotropicHormones, Pregnancy Associated Plasma Protein-A and Alpha-fetoproteinin HIV Pregnant Women at NAUTH Nnewi, Nigeria

Possible Changes in Maternal Plasma Cortisol, AdrenocorticotropicHormones, Pregnancy Associated Plasma Protein-A and Alpha-fetoproteinin HIV Pregnant Women at NAUTH Nnewi, Nigeria

Clinical characteristics and obstetrical principals at HIV-infected women in Saint Petersburg

First trimester maternal uterine artery Doppler examination in HIV-positive women

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