ABSTRACTObjective To contextualize conflicting evidence regarding the association between maternal HIV infection and preeclampsia Study Design We compared Rittenhouse et al. prospective data (2015–2022), where standardized phenotyping and marginal standardization estimated reduced preeclampsia risk in HIV-positive women, with our retrospective population-based analysis (1989–2015), which found increased risk, particularly in HAART-exposed pregnancies. Differences in surveillance, outcome definitions, covariate adjustment, and ART era/regimen were examined, alongside mechanistic hypotheses and suggested additional analyses. Results In Zambia, HIV infection was associated with lower preeclampsia risk (adjusted RR 0.42, 95% CI 0.26–0.59), persisting across ART strata, viral load, CD4 count, and severe disease. In Naples, HIV-infected women had higher risk versus HIV-negative women (10.2% vs 4.1%; adjusted OR 2.68, 95% CI 1.96 to 3.64), with excess risk concentrated among HAART users. A unifying mechanistic framework posits that long-standing immune suppression or quiescence may lower risk, whereas rapid immune reconstitution after ART initiation may elevate risk. Conclusion Apparent contradictions between cohorts may reflect context-specific interactions between HIV, ART, maternal immunity, and clinical practice. HIV-positive pregnancies require vigilant monitoring and preconception optimization of ART and cardiometabolic health.
Saccone et al. (Fri,) studied this question.