A recent study funded by the National Institutes of Health (NIH) has found that pregnant people with HIV face a higher risk for hypertensive disorders of pregnancy if they have low CD4+ immune cell counts in the first or second trimester or if they begin taking antiretroviral drug regimens after 20 weeks of pregnancy, rather than at conception.
Hypertensive disorders of pregnancy, including chronic hypertension, gestational hypertension, preeclampsia, and eclampsia, are common causes of maternal illness and death. It has been previously observed that people with HIV may be more susceptible to these disorders compared to those without HIV, particularly if they are not taking antiretroviral drugs.
To investigate this further, the researchers analyzed the medical records of pregnant individuals with HIV enrolled in an NIH-funded study. The study included data from 973 pregnancies, with 948 of them involving individuals taking antiretroviral drugs.
The results revealed that 9.5% of the participants experienced new-onset hypertensive disorders, 9.8% had chronic hypertension, and 81% did not have hypertension. Participants with low CD4+ counts in the first or second trimester were found to have twice the risk for a new-onset hypertensive disorder compared to those with higher CD4+ counts. Additionally, individuals who started antiretroviral therapy after 20 weeks of pregnancy had nearly twice the risk for a new-onset hypertensive disorder compared to those who were already on medication when they became pregnant.
The study emphasizes the importance of managing HIV and achieving optimal immune status before becoming pregnant to mitigate the risk of hypertensive disorders during pregnancy. It suggests that early initiation of antiretroviral therapy and maintaining adequate immune cell counts play crucial roles in reducing these risks.
Overall, this research provides valuable insights into the association between antiretroviral therapy, immune status, and hypertensive disorders of pregnancy in people with HIV. It underlines the need for comprehensive HIV treatment and care prior to conception to ensure the best outcomes for pregnant individuals with HIV.
– Yee, LM, et al. Evaluating the association of antiretroviral therapy and immune status with hypertensive disorders of pregnancy among people with HIV. AIDS. 2023.