title: Pre-eclampsia, antiretroviral therapy, and immune reconstitution.
abstract: Antiretrovirals are standard treatment for HIV-1-positive women during pregnancy in the UK, but little is known about maternal or fetal safety. In our cohort study of 214 pregnant women with HIV-1 infection, those who received no antiretroviral therapy had a rate of pre-eclampsia significantly lower (none of 61) than those on triple antiretroviral therapy (8 of 76; odds ratio 15.3, 95% CI 0.9-270, p=0.0087). However, the rate of pre-eclampsia in HIV-1-positive women on treatment did not differ from that in uninfected controls (12 of 214; p=0.2). The association of HIV-1-related immune deficiency with a low rate of pre-eclampsia, and the restoration of this rate in women treated with triple antiretroviral therapy to the expected rate indicates a pivotal role of the immune system in the pathogenesis of pre-eclampsia. The clinical presentation of pre-eclampsia and toxic effects of antiretroviral therapy could overlap and complicate diagnosis and management in these patients.
authors.affiliation: Department of Obstetrics and Gynaecology, Guys and St Thomas' NHS Trust, London, UK. r.wimalasundera@ic.ac.uk
authors.forename: R C
authors.initials: RC
authors.lastname: Wimalasundera
authors.forename: N
authors.initials: N
authors.lastname: Larbalestier
authors.forename: J H
authors.initials: JH
authors.lastname: Smith
authors.forename: A
authors.initials: A
authors.lastname: de Ruiter
authors.forename: S A
authors.initials: SA
authors.lastname: McG Thom
authors.forename: A D
authors.initials: AD
authors.lastname: Hughes
authors.forename: N
authors.initials: N
authors.lastname: Poulter
authors.forename: L
authors.initials: L
authors.lastname: Regan
authors.forename: G P
authors.initials: GP
authors.lastname: Taylor
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016516:CD4-CD8 Ratio; D004359:Drug Therapy, Combination; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000517:prevention & control; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011225:Pre-Eclampsia / Q000276:immunology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000276:immunology; D011295:Prenatal Care
chemical_list: D019380:Anti-HIV Agents