title: Antiretrovirals causing severe pre-eclampsia.
abstract: BACKGROUND
  Extremely low birth weight infants (ELBW) (⩽1000g) at our tertiary hospital have a much higher HIV exposure rate than bigger babies and are mainly delivered due to complications of pre-eclampsia. Studies investigating the effect of HIV or antiretroviral therapy on pre-eclampsia, a partially immune-mediated disease have produced contradictory results.
  
  
  OBJECTIVE
  To determine if there was an association between pre-eclampsia and HIV and/or antiretrovirals in the mothers of ELBW infants.
  
  
  METHODS
  A prospective database was maintained for all ELBW infants born from August 2011 till January 2013. Data included maternal information such as HIV status, antiretroviral medication (duration and type) and mode and indication for delivery.
  
  
  RESULTS
  Of the 195 mothers who delivered ELBW infants, 46 (24%) were HIV positive. This is significantly different to the 17% HIV prevalence in mothers with bigger children (p=0.02). The main indication (59%) for delivery of the infant was hypertension related with the majority of these (94%) being classified as pre-eclampsia. Although HIV on its own showed no association (p=0.13), mothers who received greater than 4weeks of antiretrovirals were more likely to develop severe pre-eclampsia (p=0.007).
  
  
  CONCLUSIONS
  The debate about ARVs and PET is not yet over. We postulate that in a small group of susceptible women, ARVs may trigger early severe PET. It is unclear from our study if this would be due on a toxic or immune basis.
authors.affiliation: Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: Lloyd.tooke@uct.ac.za.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Tooke
authors.affiliation: Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: linda.j.riemer@gmail.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Riemer
authors.affiliation: Department of Obstetrics, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: mushi.matjila@uct.ac.za.
authors.forename: Mushi
authors.initials: M
authors.lastname: Matjila
authors.affiliation: Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: mc.harrison@uct.ac.za.
authors.forename: Michael
authors.initials: M
authors.lastname: Harrison
mesh_terms: D019380:Anti-HIV Agents / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D036861:Delivery, Obstetric; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D019259:Lamivudine / Q000009:adverse effects; D019829:Nevirapine / Q000009:adverse effects; D011225:Pre-Eclampsia / Q000139:chemically induced*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D000068698:Tenofovir / Q000009:adverse effects; D015215:Zidovudine / Q000009:adverse effects
chemical_list: D019380:Anti-HIV Agents; D019259:Lamivudine; D015215:Zidovudine; D019829:Nevirapine; D000068698:Tenofovir