Lloyd Tooke1, Linda Riemer2, Mushi Matjila3, Michael Harrison4. 1. Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: Lloyd.tooke@uct.ac.za. 2. Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: linda.j.riemer@gmail.com. 3. Department of Obstetrics, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: mushi.matjila@uct.ac.za. 4. Department of Neonatology, Groote Schuur Hospital, University of Cape Town, South Africa. Electronic address: mc.harrison@uct.ac.za.
Abstract
BACKGROUND: Extremely low birth weight infants (ELBW) (⩽1000g) at our tertiary hospital have a much higher HIV exposure rate than bigger babies and are mainly delivered due to complications of pre-eclampsia. Studies investigating the effect of HIV or antiretroviral therapy on pre-eclampsia, a partially immune-mediated disease have produced contradictory results. OBJECTIVE: To determine if there was an association between pre-eclampsia and HIV and/or antiretrovirals in the mothers of ELBW infants. STUDY DESIGN: A prospective database was maintained for all ELBW infants born from August 2011 till January 2013. Data included maternal information such as HIV status, antiretroviral medication (duration and type) and mode and indication for delivery. RESULTS: Of the 195 mothers who delivered ELBW infants, 46 (24%) were HIV positive. This is significantly different to the 17% HIV prevalence in mothers with bigger children (p=0.02). The main indication (59%) for delivery of the infant was hypertension related with the majority of these (94%) being classified as pre-eclampsia. Although HIV on its own showed no association (p=0.13), mothers who received greater than 4weeks of antiretrovirals were more likely to develop severe pre-eclampsia (p=0.007). CONCLUSION: The debate about ARVs and PET is not yet over. We postulate that in a small group of susceptible women, ARVs may trigger early severe PET. It is unclear from our study if this would be due on a toxic or immune basis.
BACKGROUND: Extremely low birth weight infants (ELBW) (⩽1000g) at our tertiary hospital have a much higher HIV exposure rate than bigger babies and are mainly delivered due to complications of pre-eclampsia. Studies investigating the effect of HIV or antiretroviral therapy on pre-eclampsia, a partially immune-mediated disease have produced contradictory results. OBJECTIVE: To determine if there was an association between pre-eclampsia and HIV and/or antiretrovirals in the mothers of ELBW infants. STUDY DESIGN: A prospective database was maintained for all ELBW infants born from August 2011 till January 2013. Data included maternal information such as HIV status, antiretroviral medication (duration and type) and mode and indication for delivery. RESULTS: Of the 195 mothers who delivered ELBW infants, 46 (24%) were HIV positive. This is significantly different to the 17% HIV prevalence in mothers with bigger children (p=0.02). The main indication (59%) for delivery of the infant was hypertension related with the majority of these (94%) being classified as pre-eclampsia. Although HIV on its own showed no association (p=0.13), mothers who received greater than 4weeks of antiretrovirals were more likely to develop severe pre-eclampsia (p=0.007). CONCLUSION: The debate about ARVs and PET is not yet over. We postulate that in a small group of susceptible women, ARVs may trigger early severe PET. It is unclear from our study if this would be due on a toxic or immune basis.
Authors: Michele K Saums; Caroline C King; Jenna C Adams; Anandi N Sheth; Martina L Badell; Marisa Young; Lynn M Yee; Ellen G Chadwick; Denise J Jamieson; Lisa B Haddad Journal: Obstet Gynecol Date: 2019-12 Impact factor: 7.661
Authors: Malango T Msukwa; Olivia Keiser; Andreas Jahn; Joep J van Oosterhout; Andrew Edmonds; Nozgechi Phiri; Ronald Manjomo; Mary-Ann Davies; Janne Estill Journal: Trop Med Int Health Date: 2019-04-01 Impact factor: 2.622
Authors: Elizabeth M Stringer; Michelle A Kendall; Shahin Lockman; Thomas B Campbell; Karin Nielsen-Saines; Fred Sawe; Susan Cu-Uvin; Xingye Wu; Judith S Currier Journal: PLoS One Date: 2018-07-18 Impact factor: 3.240