In a temporal perspective, the first studies regarding the influence of human immunodeficiency virus (HIV) on the occurrence of preeclampsia (PE) indicated that in HIV-infected pregnant women, PE would be reduced due to the immunological and endothelial changes subsequent to viral infection. However, with the advent of highly active antiretroviral therapy (HAART) and the possibility of minimizing or eliminating immunological and inflammatory changes, the risk of developing PE in HIV-infected pregnant women would be expected to increase (Machado. J Infect 2014;68:572–80). Even though a meta-analysis did not confirm this association (Brown. J Acquir Immune Defic Syndr 2015;70:91–8), a more recent publication supported this assertion (Sansone. Obstet Gynecol 2016;127:1027–32). There are a great number of studies on HIV infection in pregnant women in association with PE; however, only a few evaluated the influence of PE on the rate of HIV vertical transmission (VT). It is known that PE is a systemic disorder with abnormal activation of immune and inflammatory responses including in the placenta. These changes resemble the response to HIV infection and impact placental expression of tissue receptors involved in VT of HIV. Ultimately, knowledge of the influence of PE on expression of these receptors could influence strategies to prevent and control PE and strengthen measures to reduce the VT of HIV. Dorsamy et al. precisely assessed whether PE alters the expression of receptors in the placenta and umbilical cord that are linked to intrauterine transmission of HIV. They detected markers of HIV infection (p. 24, CD4 lymphocytes, CCR5 and ICAM-2) in trophoblast and umbilical cord tissue from both normotensive and preeclamptic HIV-infected pregnant women. The expression of CCR5 was significantly increased in both preeclamptic and normotensive HIV-infected women, showing that PE can increase the risk of VT of HIV. Increased expression of CCR5 on trophoblastic membrane coupled with the expression of CD4 receptor can also increase vulnerability to HIV infection. It was further observed that ICAM-2 had a significantly higher expression in placental tissue of HIV-negative preeclamptic women when compared with the HIV-positive groups under HAART, supporting that HAART protects against the VT of HIV. Conversely, improvements in immunological parameters in HIV-infected pregnant women and the high levels of HIV receptors in syncytiotrophoblast of normotensive pregnant women possibly exacerbate the risk of PE. These findings justify the need to continue use of antiretroviral drugs for the mother during her prenatal care, and during labour, delivery and the postpartum period (Luzuriaga, Mofenson. N Engl J Med 2016;374:761–70). Furthermore, it also indicates the need for special monitoring of pregnant women on HAART, including blood pressure evaluations at short intervals, to optimize specific screening and prophylactic care for PE (O'Gorman. BMJ Open 2016;6:e011801). None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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