Evaluating the association of antiretroviral therapy and immune status with hypertensive disorders of pregnancy among people with HIV

Lynn M. Yee*, Denise L. Jacobson, Lisa B. Haddad, Jennifer Jao, Kathleen M. Powis, Deborah Kacanek, Rebecca Zash, Alexandria Diperna, Ellen G. Chadwick

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective:The aim of this study was to examine the association of timing of antiretroviral therapy (ART) initiation and ART class with risk of new-onset hypertensive disorders of pregnancy (HDP) among people with HIV (PWH).Design:An observational study of participants in the multisite Surveillance Monitoring for ART Toxicities (SMARTT) study.Methods:Data were abstracted from medical records of pregnant PWH enrolled in SMARTT (January 30, 2015 to March 25, 2019). New-onset HDP included gestational hypertension, preeclampsia/eclampsia, or HELLP syndrome. We examined the associations of clinical risk factors and three exposures of interest, each in a separate model, with risk of new-onset HDP. Log-binomial regression models were fit using generalized estimating equations to account for correlations within people. Exposures included timing of ART initiation, antiretroviral class among those on therapy at conception, and antiretroviral class among those initiating treatment during pregnancy.Results:Of 1038 pregnancies in this cohort, 973 were singletons with complete data on HDP, with ART use in 948. Overall, 9% had a new-onset HDP, 10% had chronic hypertension, and 81% had no hypertension. Diabetes [adjusted relative risk (aRR) 2.44, 95% confidence interval (95% CI) 1.42-4.21] and first/second trimester CD4+cell count less than 200 cells/μl (aRR 1.99, 95% CI 1.21-3.27) were associated with a greater risk of new-onset HDP. Risk of new-onset HDP was similar by antiretroviral class, but those initiating ART after 20 weeks' gestation had a greater risk (aRR 1.93, 95% CI 1.12-3.30) compared with those receiving ART at conception.Conclusion:In this large, diverse cohort of pregnant PWH, worse early pregnancy immune status and later ART initiation were associated with an increased risk of HDP while ART class was not.

Original languageEnglish (US)
Pages (from-to)1715-1723
Number of pages9
JournalAIDS
Volume37
Issue number11
DOIs
StatePublished - Sep 1 2023

Keywords

  • HIV
  • antiretroviral therapy
  • hypertensive disorders of pregnancy
  • preeclampsia

ASJC Scopus subject areas

  • Infectious Diseases
  • Immunology and Allergy
  • Immunology

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