Antiretrovirals causing severe pre-eclampsia

Background Extremely low birth weight infants (ELBW) (⩽1000 g) 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 4 weeks 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.