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

• Published in: AIDS (London) Vol. 20; no. 1; pp. 59 - 66
• Main Authors: SUY, Anna, MARTINEZ, Esteban, MALLOLAS, Josep, LEON, Agathe, VANRELL, Juan A, GATELL, José M, COLL, Oriol, LONCA, Montserrat, PALACIO, Montserrat, DE LAZZARI, Elisa, LARROUSSE, Maria, MILINKOVIC, Ana, HERNANDEZ, Sandra, BLANCO, José L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 02.01.2006
• Subjects: Adult; Antiretroviral Therapy, Highly Active - adverse effects; Biological and medical sciences; Diseases of mother, fetus and pregnancy; E-Selectin - blood; Female; Fetal Death - chemically induced; Fetal Death - etiology; Gynecology. Andrology. Obstetrics; HIV Infections - complications; HIV Infections - drug therapy; Human immunodeficiency virus; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Insulin - blood; Medical sciences; P-Selectin - blood; Parity; Pre-Eclampsia - chemically induced; Pre-Eclampsia - etiology; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Outcome; Pregnancy. Fetus. Placenta; Prospective Studies; Risk Factors; Smoking - adverse effects; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Prognosis; Pregnancy disorders; Mortality; AIDS; Immune deficiency; Pregnancy toxemia; Infection; Chemotherapy; Treatment; Viral disease; Preeclampsia; Risk factor; Antiviral; Female; Woman
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/01.aids.0000198090.70325.bd

Pre-eclampsia and/or fetal death have increased sharply in HIV-infected pregnant women receiving HAART. The occurrence of pre-eclampsia or fetal death was analysed in women who delivered after at least 22 weeks of gestation for all women (January 2001 until July 2003) and for HIV-infected women (November 1985 until July 2003). In 2001, 2002 and 2003, the rates per 1000 deliveries of pre-eclampsia and fetal death, respectively, remained stable in all pregnant women at 25.4, 31.9 and 27.7 (P = 0.48) and 4.8, 5.8, and 5.0 (P = 0.89) (n = 8768). In 1985-2000 (n = 390) to 2001-2003 (n = 82), rates per 1000 deliveries in HIV-infected women rose from 0.0 to 109.8 (P < 0.001) for pre-eclampsia and from 7.7 to 61.0 (P < 0.001) for fetal death. In all pregnant women, factors associated with pre-eclampsia or fetal death were multiple gestation [adjusted odds ratio (OR) 3.6; 95% confidence interval (CI), 2.3-5.6; P < 0.001], HIV infection (adjusted OR, 4.9; 95% CI, 2.4-10.1; P < 0.001), multiparity (adjusted OR, 0.76; 95% CI, 0.58-0.98; P = 0.040) and tobacco smoking (adjusted OR, 0.65; 95% CI, 0.46-0.90; P = 0.010). The use of HAART prior to pregnancy (adjusted OR, 5.6; 95% CI, 1.7-18.1; P = 0.004) and tobacco smoking (adjusted OR, 0.183; 95% CI, 0.054-0.627; P = 0.007) were risk factors in HIV-infected women. HIV infection treated with HAART prior to pregnancy was associated with a significantly higher risk for pre-eclampsia and fetal death.