AIDS and pregnancy: the virus and antiretroviral treatments favor complications and fetal death

The AIDS virus (HIV), as well as highly active antiretroviral therapy (HAART), are linked pregnant at a higher risk of complications and fetal death women, according to a study published in "Aids".
A European study had shown that preeclampsia was the most common complication among HIV-infected women and its incidence has increased since the introduction of HAART in the mid-1990s.

Preeclampsia is characterized by the association during pregnancy high blood pressure and protein in the urine. It can lead to eclampsia (convulsions followed by coma).

Anna Suy, University of Barcelona, and colleagues conducted a study of 8768 pregnant women followed between 2001 and 2003 to estimate the risk of preeclampsia and fetal death related to HIV, for which 0.9% of women (82 patients) were infected.

While the incidence of preeclampsia was 28.6 per 1,000 pregnant women in the general population, it reached 109.8 per 1,000 infected women. After adjusting the data, the researchers estimated that HIV increases the risk by a factor of 4.9.

Fetal deaths were also more common among HIV + women, with an incidence of 61 per 1,000 women against 5.3 per 1,000 in the general population. Not being able to adjust these values, however, researchers have failed to define what was the contribution of the virus to this phenomenon.

The authors also conducted a study on Schedule 472 HIV + pregnant women (not included in the first study) followed in Barcelona between 1985 and 2003. In particular, it shows that the impact of preeclampsia and fetal death had recorded a sharp rise in the pre-HAART period (before 1995).

But the researchers found that in this population taking HAART before pregnancy, which involved 97% of women in 2002 against 5% in 1997, increased the risk of preeclampsia by 8.9 times, and the fetal death 7 9 times.

"We found that the risk of preeclampsia and fetal death was higher among pregnant women infected with HIV, and that this risk was involved in the monitoring of HAART before pregnancy," the authors conclude.

"Despite these results, we believe that monitoring of HAART before and during pregnancy should not be discouraged because there is strong evidence that the benefits of treatment clearly outweigh the potential risks", they added.