Influence of HIV and its treatment on hypertensive disorders of pregnancy in women from a low- to middle-income country.

Abstract

To establish a potential relationship between hypertensive disorders of pregnancy (HDP) and HIV infection. This cross-sectional observational study involving 300 women with HDP was undertaken from September 2018 to February 2019 in a regional hospital in Durban, South Africa, a setting with a background HIV prevalence of 45% among pregnant women. All women with new-onset elevation of blood pressure after the 20th week of pregnancy were enrolled and, following informed consent, the relevant information was extracted from their files. Of the 300 women with HDP, the HIV prevalence was 30%, compared with the historical seroprevalence of 45% within the hospital (P=0.028). For all categories of HDP, there were fewer primigravid women among women living with HIV (WLHIV), compared with those uninfected (30% vs 50.2%, respectively; P=0.001). HDP developed later in gestation in WLHIV compared with uninfected women (32.6 weeks vs 34 weeks, respectively; P=0.023), however, there were significant maternal complications of abruption and elevated liver enzymes among WLHIV (P=0.02 and P =0.014, respectively). Despite this, the perinatal outcomes were similar in both groups. HIV or its treatment seems to have a protective effect in the development of HDP; however, the complications of HDP may be significant in WLHIV receiving treatment.