Human Immunodeficiency Virus and risk of Preeclampsia and Eclampsia in pregnant women: a meta-analysis on cohort studies

Background: In 2017, there were 36.9 million people living with HIV infection worldwide, of whom 1.1 million were pregnant women. Maternal HIV infection is related with several perinatal adverse outcome. This systematic review and meta-analysis study aimed to establish whether maternal HIV infection is related with development of preeclampsia (PE) or eclampsia. Methods: We comprehensively searched MEDLINE/PubMed, Web of Science, SCOPUS and Embase databases for relevant studies published up to 20 November 2018, without time and language restriction. We included observational studies with cohort design that have assessed the association between HIV infection and development of PE or eclampsia. Study quality was assessed using the Newcastle–Ottawa scale. We applied a random-effects model to calculate the relative risks (RR) and 95% confidence intervals (CI) for the meta-analyses. We did subgroup and meta-regression analyses and assessed the effect of different variables on RRs. We also systematically reviewed eligible studies to determine the effects of HIV infection on imbalance of angiogenic-antiangiogenic factors, which are effective in increased risk of PE or eclampsia. Results: Twenty two eligible studies (11 prospective and 11 retrospective cohort studies) comprising 90,514 HIV-positive and 66,085,278 HIV-negative pregnant women, were included in meta-analysis. Results of meta-analyses showed that maternal HIV infection was not significantly associated with development of PE (RR, 1.04; 95%CI, 0.89–1.21) and eclampsia (RR, 1.05; 95%CI, 0.63–1.75), in overall. In subgroup analyses, the association was still insignificant in case of PE, however we observed a significant association in retrospective cohorts (RR, 1.42; 95%CI, 1.34–1.5) and high income countries, in case of eclampsia. Moreover, six studies were included considering the effects of HIV infection on imbalance of angiogenic-antiangiogenic factors. All six studies demonstrated that HIV infection had no significant effect on expression levels of these factors in pre-ecalmptic and normotensive pregnant women. Conclusion: Our findings showed that maternal HIV has no significant association with PE, however some evidences are suggesting that it could be associated with eclampsia. Further studies with larger sample size and well defined outcomes are recommended to confirm or refute of present findings.

Keywords:

Human Immunodeficiency Virus , Preeclampsia , Eclampsia , meta-analysis