title: HIV, Antiretroviral Therapy, and Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  There are data to suggest that infection with HIV or use of highly active antiretroviral therapy increases the risk of hypertensive disorders in pregnancy. This systematic review and meta-analysis aims to provide an overview of the research hitherto.
  
  
  METHODS
  A systematic review of EMBASE, PubMed, and The Cochrane Library databases was conducted to obtain articles about the association between HIV in pregnancy and/or HIV therapy and the risk of developing pregnancy-induced hypertension (PIH), pre-eclampsia, eclampsia, or Hemolysis Elevated Liver enzymes Low Platelet count syndrome. Quality of articles was evaluated with an adapted Cochrane Collaboration bias assessment tool. Relative risks (RRs) were pooled with a random-effects meta-analysis weighted by the inverse of their variance.
  
  
  RESULTS
  Of the 2136 articles screened, 28 studies were eligible for inclusion; 15 studies reported on the association with PIH, 16 on pre-eclampsia, 5 on eclampsia, and 3 articles on HIV therapy regimens. All articles had a high risk of bias, and between-study heterogeneity was considerable. Based on the meta-analysis, there does not seem to be an association between HIV and PIH [RR 1.26, 95% confidence interval (CI): 0.87 to 1.83, I = 78.6%], pre-eclampsia (RR 1.01, 95% CI: 0.87 to 1.18, I = 63.9%), or eclampsia (RR 1.61, 95% CI: 0.14 to 18.68, I = 97.0%). A meta-analysis of the association with HIV therapy and risk of hypertensive disorders in pregnancy could not be performed.
  
  
  CONCLUSIONS
  This meta-analysis shows no significant association between HIV positivity and PIH, pre-eclampsia, or eclampsia. However, the high risk of bias within most studies limits the strength of conclusions and well-designed studies are necessary to confirm or refute these findings.
authors: *Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; †The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and ‡Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors: Joyce L
authors: JL
authors: Browne
authors: Verena J M M
authors: VJ
authors: Schrier
authors: Diederick E
authors: DE
authors: Grobbee
authors: Sanne A E
authors: SA
authors: Peters
authors: Kerstin
authors: K
authors: Klipstein-Grobusch
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004461:Eclampsia / Q000453:epidemiology*; D005260:Female; D017359:HELLP Syndrome / Q000453:epidemiology*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D018570:Risk Assessment
chemical_list: D044966:Anti-Retroviral Agents