Characteristics of HIV-infected women on antiretroviral therapy who develop preeclampsia in South Africa: a case series

Abstract

Hypertensive disorders such as preeclampsia/eclampsia and HIV are important diseases contributing to the incidence of maternal deaths and illness in South Africa. Antiretroviral therapy (ART) is an instrumental medical treatment that specifically targets the HIV virus. ART involves multiple drugs that act on the HIV virus at various points in its biologic life cycle. This treatment during pregnancy has significantly decreased mother-to-child transmission (MTCT) of HIV. Additionally, hypertensive disorders in pregnancy are characterized by increased blood pressure during the gestational period. This spectrum of disorders includes gestational hypertension, mild preeclampsia, severe preeclampsia, superimposed preeclampsia on chronic hypertension, eclampsia and HELLP syndrome, which is characterized by hemolysis, elevated liver enzymes and low platelet count. Among patients who are HIV-positive in South Africa, hypertensive disorders in pregnancy remain one of the most common complications. Therefore, the relationship between hypertensive disorders, HIV, and ART during pregnancy requires further investigation. As access to ART has increased among women of reproductive age, there is a concern about the safety of these medications in pregnancy. Five cases of HIV-infected patients on ART who developed preeclampsia were identified in a specialized antenatal clinic offering antiretroviral services within the Department of Obstetrics and Gynecology at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The maternal and neonatal characteristics and management of labor and delivery in these cases are described. The purpose of this paper is to present a case series of HIV-positive pregnant women on ART who developed preeclampsia and to perform a literature review of the relationship between ART, HIV and preeclampsia. There is a need for early identification and close follow-up of HIV-infected patients on ART who develop preeclampsia to facilitate better obstetric outcomes in these high-risk pregnancies.