Cardiovascular Journal of Africa: Vol 24 No 2 (March 2013)

CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 2, March 2013

AFRICA

Is the prevalence of pre-eclampsia affected by HIV/AIDS?

A retrospective case–control study

VMS KALUMBA, J MOODLEY, TD NAIDOO

Abstract

Objective:

To evaluate the rate of HIV/AIDS (and CD

levels)

in women with pre-eclampsia compared to that of a control

group.

Methods:

This was a retrospective case–control study in a

tertiary and regional hospital in South Africa. We reviewed

the hospital records of women who had delivered in these

hospitals between 1 January 2008 and 30 June 2010. The

records of women with pre-eclampsia during the study peri-

od were analysed. Their HIV infection rate was compared to

that of a control group consisting of normotensive healthy

pregnant women.

Results:

Among 492 cases of pre-eclampsia, 130 (26.4%) were

HIV infected. In the control group, 183/500 (36.6%) were

HIV infected (

0.001, OR

0.62, 95% CI: 0.47–0.82).After

adjustment to match the difference in maternal age and

parity, the rate of HIV/AIDS was lower in the pre-eclamptic

group than in the control group (

0.005, OR

0.658).

Conclusion:

The rate of HIV/AIDS was significantly lower

in women with pre-eclampsia than in normotensive healthy

pregnant women.

Keywords:

HIV, CD

count, pre-eclampsia, eclampsia, preg-

nancy

Submitted 16/5/12, accepted 23/10/12

Cardiovasc J Afr

2013;

: 24–27

www.cvja.co.za

DOI: 10.5830/CVJA-2012-078

Pre-eclampsia, a condition unique to human pregnancy, clinically

presents with hypertension and proteinuria after the 20th week

of gestation. It complicates 7–10% of pregnancies worldwide

and is a major cause of maternal and perinatal morbidity

and mortality.

1,2

The current understanding of the aetiology

of pre-eclampsia remains unclear.

It has been proposed that

placental maladaptation leads to decreased utero-placental blood

flow and subsequent intracellular hypoxia, resulting in the

release of various substances including trophoblastic debris

and apoptotic cells. These cause an imbalance between anti-

angiogenic and angiogenic factors, resulting in widespread multi-

organ endothelial dysfunction.

The end result is generalised

vasospasm, hypertension and multiple organ affectation.

Although much of the pathophysiology of pre-eclampsia

is known, the current debate is what causes the placental

maladaptation. It is believed that immunological factors may

be involved in initiating the cascade of events mentioned

above.

2,4

Also, pre-eclampsia has been shown to represent an

excessive generalised maternal sterile inflammatory response to

pregnancy.

5,6

Further, it has been postulated that the frequency of

pre-eclampsia may be affected by immunosuppressive conditions

such as HIV/AIDS

.4,7-9

Data on the impact of HIV on the rate of pre-eclampsia are

conflicting. There is no consensus as to whether HIV-infected

women are at a lower, equal or higher risk of developing

pre-eclampsia than the general population. Most studies have

included small sample sizes and/or have been retrospective chart

reviews.

In South Africa, approximately 30% of antenatal patients

are infected with HIV.

Also, non-pregnancy related infections

(mainly HIV/AIDS) and hypertensive disorders are the

commonest causes of maternal mortality and morbidity.

Hence,

South Africa represents an ideal site for a study involving HIV

and pre-eclampsia.

The aim of this study was to evaluate the association between

HIV infection and pre-eclampsia. To test the hypothesis that

women with pre-eclampsia are less likely to be affected by HIV/

AIDS, the rate of HIV in pre-eclamptics was compared to that

of a control group without pre-eclampsia. In addition, the CD

count levels between the two groups were compared to test the

hypothesis that immune-suppression could have a protective

effect against pre-eclampsia.

Methods

This was a retrospective case–control study conducted at Grey’s

and Edendale hospitals (a tertiary and a regional hospital,

respectively) in Pietermaritzburg, South Africa. The maternity

birth registries in the two study sites were reviewed.

Women who had delivered between January 2008 and June

2010 with a diagnosis of pre-eclampsia were identified and

their hospital files were retrieved from the medical registry.

Those meeting the inclusion criteria were selected and all

relevant data were collected on a structured data sheet until

the estimated sample size was reached. The inclusion criteria

were a diagnosis of pre-eclampsia, known HIV status, singleton

pregnancy and no evidence of other chronic medical conditions,

namely hypertension, diabetes, renal disease and connective

tissue disease.

The exclusion criteria were women with unknown/unrecorded

HIV status, multiple pregnancy and chronic hypertension.

Subsequently, an equivalent number of women without

pre-eclampsia (control group) were randomly selected to

match the case criteria. With the exception of the diagnosis of

pre-eclampsia, the inclusion and exclusion criteria of the controls

were similar to those of the cases.

Department of Obstetrics and Gynaecology,

Pietermaritzburg Complex of Academic Hospitals; Women’s

Health and HIV Research Group, Department of Obstetrics

and Gynaecology, University of KwaZulu-Natal, Durban,

South Africa

VMS KALUMBA, FCOG,

vitakal@yahoo.fr

J MOODLEY, MD,

jmog@ukzn.ac.za

TD NAIDOO, FCOG