AEGiS-15IAC: Increased risk of pre-pclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Increased risk of pre-pclampsia and fetal death in HIV-infected pregnant women receiving highly active antiretroviral therapy.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. ThOrB1359)

Suy A, Coll O, Martinez E, Lonca M, de Lazzari E, Pisa S, Larrouse M, Milinkovic A, Hernandez S, Blanco JL, Mallolas J, Garcia F, Miro JM, Cararach V, Vanrell JA, Gatell JM
Hospital Clinic, Barcelona, Spain

BACKGROUND: We have recently detected an increasing number of pre-eclampsia (PE) and fetal death (FD) in HIV-infected pregnant women receiving highly active antiretroviral therapy (HAART). We aimed to study the incidence and the risk for PE and FD in HIV-infected women.

METHODS: All pregnant women with available data delivering (at least 22 weeks of gestation) in our institution were included. Factors related to demographics, pregnancy, HIV infection, and antiretroviral therapy were assessed to detect any potential association with PE and FD, defined as bad outcome. Multivariate analyses for bad outcome considering all pregnant women, and all HIV-infected women were done.

RESULTS: From 1/01 to 8/03, 8295 women delivered and 82 (0.9%) were HIV-infected. There were 237 (2.9%) PE and 40 (0.5%) FD. In that period, the rates of PE (9 HIV-infected, 11.0% vs 242 non-HIV-infected, 2.8%; RR 4.3 95%CI 1.9-9.0) and FD (6 HIV-infected, 6.1% vs 41 non-HIV-infected, 0.5%; RR 13.7 95%CI 5.3-35.6) were significantly higher in HIV-infected women (p<0.01). Multiple gestation (adjusted OR 3.0, 95% CI 1.9-4.7), HIV infection (adjusted OR 4.6, 95% CI 2.3-9.1), multiparity (adjusted OR 0.70, 95% CI 0.54-0.90) and tobacco (adjusted OR 0.71, 95% CI 0.52-0.96) were independent factors for bad outcome in all pregnant women. From 11/85 to 8/03, data from 472 HIV-infected pregnant women were available: 258 from 1985 to 1994 (no antiretroviral therapy period), 74 from 1994 to 1998 (mono/double therapy period), and 140 from 1998 to 2003 (HAART period). Vertical transmission in these 3 periods was 12%, 4%, and 0%, respectively. Cases of PE and FD were: 0 (0%) and 2 (0.8%), 0 (0%) and 0 (0%), and 9 (6.4%), and 6 (4.2%), respectively. HAART before pregnancy (adjusted OR 5.6, 95% CI 1.7-17.9) and tobacco (adjusted OR 0.18, 95% CI 0.05-0.62) were independent factors for bad outcome in HIV-infected women. Conclusion An unexpected increasing rate of PE and FD has been identified in HIV-infected pregnant women on HAART. Longer HAART prior to pregnancy was associated with a higher risk.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Acquired Immunodeficiency Syndrome, HIV Seropositivity, HIV Infections, Disease Transmission, Vertical, HIV-1, Fetal Death, HIV-2, Carcinoma in Situ, Pregnant Women, Humans, Female, Pregnancy, transmission

040711
ThOrB1359