Combined antiretroviral therapy for HIV and the risk of hypertensive disorders of pregnancy: A systematic review

• Type of Material: Article
• Authors: Ashish Premkumar, Northwestern University; Annie M. Dude, Northwestern University; Lisa Haddad, Emory University; Lynn M. Yee, Northwestern University
• Language: English
• Date: 2019-07-01
• Publisher: Elsevier Science Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.preghy.2019.05.015
• Title of Journal or Parent Work: Pregnancy Hypertension
• Volume: 17
• Start Page: 178
• End Page: 190
• Grant/Funding Information: Lynn M. Yee M.D., M.P.H. is supported by the NICHD K12 HD050121–11.; Lisa B. Haddad M.D., M.S., M.P.H.is supported by the NICHD K23 5K23HD078153–04.
• Keywords: Less common; Peripheral Vascular Disease; Aspirin; Haart; Infected women; cART; Prevention; Hypertensive disorders of pregnancy; Antiretroviral therapy; Pregnancy; HIV; Delivery; Complications; Science & Technology; Cardiovascular System & Cardiology; Eclampsia; Outcomes; Preeclampsia; Obstetrics & Gynecology; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Public Health; Health Sciences, Rehabilitation and Therapy; Health Sciences, Obstetrics and Gynecology; Health Sciences, Pathology

Abstract

Objective: To assess if there is a relationship between use of combined antiretroviral therapy among pregnant women living with HIV and hypertensive disorders of pregnancy (HDP). Design: Due to the heterogeneity of study designs in the literature and the utilization of different outcome measures in regards to assessing the presence of HDP, a systematic review was performed. Methods: ClinicalTrials.gov and MEDLINE, via PubMed, EMBASE, Scopus, CINAHL, ProQuest Dissertations & Theses Global, EBSCOHost, DARE, and the Cochrane Library, were queried from January 1997 to October 2017. Studies were included if they reported HDP and focused on pregnant women living with HIV who used combined antiretroviral therapy. The Cochrane Collaboration's tool for assessment of risk of bias and the U.S. Preventive Services Task Force grading scale were used to assess the studies. Results: Of 1055 abstracts, 28 articles met inclusion criteria. The data are marked by multiple biases and poor study design. All studies demonstrate an increased risk of HDP among pregnant women living with HIV who used combined antiretroviral therapy when compared to seropositive pregnant women not using antiretroviral therapy. Three studies suggest protease inhibitors may be associated with a higher risk of HDP. Conclusion: Despite all studies indicating a higher frequency of HDP among pregnant women living with HIV using combined antiretroviral therapy when compared with seropositive pregnant women not using antiretroviral therapy, the quality of the studies is mixed, necessitating further research.