Timing of onset and severity of pre-eclampsia in HIV positive pregnant women on antiretroviral therapy compared to HIV negative pregnant women
Background: The association between pre-eclampsia, HIV infection and antiretroviral therapy (ART) is poorly understood. Little is known about the timing of onset and severity of disease in HIV-positive patients on ART. Objective: To compare the timing of onset and severity of pre-eclampsia amongst HIV-positive pregnant patients on ART and HIV-negative pregnant patients. Secondary outcomes included maternal and neonatal outcomes. Methods: A retrospective record review of patients with pre-eclampsia who delivered at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between 1 July and 31 December of 2017 was done. Results: Of the 100 patients enrolled in the study, 79% were HIV-negative and 21% were HIV-positive. HIV-positive patients had an earlier gestational age of onset of pre-eclampsia, 30±5 weeks vs. 32.5±4.9 weeks (p<0.05), and consequently an earlier gestation at delivery compared to HIV-negative patients, 31.3±4.5 weeks vs. 34±4.9 weeks (p<0.05). The incidence of severe pre-eclampsia was similar in the two groups with a odds ratio (OR) of 1.08 (95% confidence interval (CI) 0.38 - 3) There was no difference in maternal outcomes, but neonatal outcomes were poorer in the HIV19 positive group with fewer live births with an OR of 0.24 (CI 0.06 - 0.86), and more ntrauterine fetal deaths with an OR of 7.92 (CI 1.57 - 39.67). Conclusion: In this study, HIV-positive pregnant patients on ART had earlier onset of pre-eclampsia. There was no statistical difference in severity of disease and maternal outcomes but HIV-positive patients had poorer neonatal outcomes. Further studies are needed to confirm these findings.
A research report submitted in partial fulfilment of the requirements for the degree of Master of Medicine in Obstetrics and Gynaecology to the Faculty of Health Sciences, School of Clinical Medicine, University of Witwatersrand, Johannesburg, 2022