Abstract
Purpose of the review: This review highlights the role of angiogenesis, lymphangiogenesis, and immune markers in human immunodeficiency virus (HIV)-associated preeclamptic (PE) pregnancies in an attempt to unravel the mysteries underlying the duality of both conditions in South Africa. Recent findings: Studies demonstrate that HIV-infected pregnant women develop PE at a lower frequency than uninfected women. In contrast, women receiving highly active anti-retroviral therapy (HAART) are more inclined to develop PE, stemming from an imbalance of angiogenesis, lymphangiogenesis, and immune response. Summary: In view of the paradoxical effect of HIV infection on PE development, this study examines angiogenesis, lymphangiogenesis, and immune markers in the highly HIV endemic area of KwaZulu-Natal. We believe that HAART re-constitutes the immune response in PE, thereby predisposing women to PE development. This susceptibility is due to an imbalance in the angiogenic/lymphangiogenic/immune response as compared to normotensive pregnant women. Further large-scale studies are urgently required to investigate the effect of the duration of HAART on PE development.
Highlights
The adoption of the Millennium Development Goals from 1990–2015 led to a decline in global maternal mortality by 44%; South Africa (SA) was unable to reach the target set by the United Nations (Millenium Development Goals, 2015 Report)
We provide data based on highly active anti-retroviral treatment (HAART) on reconstituting the immune system and its influence on PE development
Whilst an imbalance in the angiogenic and lymphangiogenic transference predominates in PE, we highlight the parodist effect of human immunodeficiency virus (HIV) as it utilizes its accessory proteins to exploit vascular endothelial growth factors (VEGFs)’s effect
Summary
The adoption of the Millennium Development Goals from 1990–2015 led to a decline in global maternal mortality by 44%; South Africa (SA) was unable to reach the target set by the United Nations (Millenium Development Goals, 2015 Report). Despite a decline in maternal deaths from human immunodeficiency virus (HIV) infection and obstetric hemorrhage over the period 2008–2016, no change in mortality emanating from hypertensive diseases in pregnancy (HDP) occurred [2]. Hypertensive diseases in pregnancy account for 18% of all maternal deaths in SA [3]. The World Health Organization (WHO) reported that this multisystem pregnancy disorder accounts for 1.6% of maternal deaths in developed countries [6] and 1.8–16.7% in developing countries such as South Africa, Egypt, Tanzania, and Ethiopia [7,8]
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