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.
Highlights
There were no difference on rates of gestational hypertension and preeclampsia in women who started treatment during pregnancy and in women already treated before pregnancy (n.s.; p = 0.2575) (Figure 3)
Our results showed that there were no difference on rates of gestational hypertension and preeclampsia in women who started treatment during pregnancy and in women already treated before pregnancy
We showed a trend of a higher rate of hypertensive complications in human immunodeficiency virus (HIV)-positive African-American Black women compared to HIV-positive Caucasian white women, and a trend of a lower rate of gestational hypertension and preeclampsia in African-American Black HIV-positive women compared to HIV-negative women of the same ethnic group
Summary
Hypertensive disorders in pregnancy are a leading direct cause of maternal and perinatal morbidity and mortality in the developed [1] [2] and developing world [3]-[6]; they are common obstetric complications [7]-[10] with a reported incidence of approximately 10% among pregnancies [11] [12].It is well documented that genetic [13] [14] and socio-demographic factors, such as ethnic group, have an influence on the incidence of preeclampsia and gestational hypertension [15]; in African-American Black women the incidence of preeclampsia is much higher and it has a much more aggressive and rapid clinical course of presentation, leading to significant mortality [16]-[19].Preeclampsia is characterized by impaired placentation and it involves an enhanced maternal systemic inflammatory response [20] associated with diffuse endothelial cell activation, but the current understanding of the aetiology of preeclampsia still remains unclear [21]-[24]. Hypertensive disorders in pregnancy are a leading direct cause of maternal and perinatal morbidity and mortality in the developed [1] [2] and developing world [3]-[6]; they are common obstetric complications [7]-[10] with a reported incidence of approximately 10% among pregnancies [11] [12]. The role of the immune system as an etiological factor was first proposed by Need [25] and expanded upon by other authors [26]-[28]. According to this hypothesis, some authors postulated that the frequency of preeclampsia may be affected by immunosuppressive conditions, such as human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS)
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