First trimester maternal uterine artery Doppler examination in HIV-positive women

Abstract

The aim of the current study was to assess the effect of maternal HIV infection, treated or untreated, on the degree of placental invasion, as assessed by the pulsatility index of the uterine arteries during a Doppler examination at 11 1 0 -13 1 6 weeks' gestation. MethodsThis was a nested case-control study in which a uterine artery Doppler examination was performed in the first trimester in 76 HIV-positive women. Each woman was matched with 30 HIV-negative women. As the pulsatility index of the uterine arteries depends on a number of maternal and fetal characteristics, its values in each case and control were expressed as multiples of the median (MoM) of the unaffected group. ResultsAmong the 76 HIV-positive women, 33 (43.4%) were on antiretroviral treatment at the time of the Doppler examination, including 14 women (42.4%) on nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor, 18 women (54.5%) on NRTIs and a nonnucleoside reverse transcriptase inhibitor and one woman (3.1%) on monotherapy. Compared with the HIV-negative women, the HIV-positive women were more likely to be heavier (Po0.01), to be of African origin (Po0.01), to be nonsmokers (P 5 0.01) and to deliver smaller neonates earlier (Po0.01). The median adjusted pulsatility index of the uterine arteries was not statistically different between the cases and controls [1.07; interquartile range (IQR) 0.85-1.24 MoM vs. 0.99; IQR 0.81-1.20 MoM; P = 0.28] or, in HIV-positive women, between those receiving and not receiving antiretroviral treatment (P 5 0.12). ConclusionsHIV-positive women with uncomplicated pregnancies have normal placental perfusion in the first trimester of pregnancy.Keywords: Doppler examination, HIV, pregnancy, uterine artery Accepted 1 March 2011 IntroductionThe increased incidence of HIV infection globally, the introduction of routine antenatal screening for HIV and the use of highly active antiretroviral therapy (HAART) in pregnancy have resulted in an increase in the number of pregnant women who are living with HIV. In the United Kingdom, it has been estimated that the prevalence of HIV infection in pregnancy is about 2.8 per 1000 women [1-3].There is controversy over whether HIV infection and/or its treatment has an adverse effect on placentation and the incidence of pre-eclampsia (PE) [4][5][6][7][8]. The accepted model for the development of PE is based on an underperfused, hypoxic placenta which releases a pre-eclamptic factor(s), which in turn attacks the maternal endothelium, causing endothelial dysfunction and the clinical signs of PE [9]. The uteroplacental vascular adaptation to supply the fetoplacental unit is dependent on invasion of the spiral arteries by the trophoblast and their conversion from narrow high-resistance vessels to dilated low-resistance channels. Studies assessing the uteroplacental circulation by Doppler ultrasound have reported that, in pregnancies DOI: 10.1111/j.1468-1293.00930.x HIV Medicine (2011 r 2011 British HIV Association 632 in which PE develops, there is an increased...

Hypertension, preeclampsia and eclampsia among HIV-infected pregnant women from Latin America and Caribbean countries

“…In addition, regarding HIV-infected patients, some ART has been associated with endothelial dysfunction and CVD 44 . Nevertheless, Torriani et al (2008) 45 , comparing three different randomized ARV regimens among HIV-infected naïve individuals, in order to evaluate the effect of these ARV on endothelial function, noticed rapid improvement of endothelial function after ARV administration. Savvidou et al (2011) evaluated the uteroplacental circulation by Doppler ultrasound of HIV-infected and non-infected pregnant women in the first trimester of gestation – a probable early biomarker to predict PE –, with the aim to assess the degree of placental invasion.…”

Angiogenesis, Lymphangiogenesis, and the Immune Response in South African Preeclamptic Women Receiving HAART

“…A study done by Torriani et al (2008) showed improved endothelial function after ARV administration [97]. Additionally, Savvidou et al (2011) found normal placental perfusion among HIV-infected women, with uncomplicated pregnancies, receiving and not receiving HAART [98]. In contrast, a study done by Sebitloane et al (2017) evaluating the effect of HAART on HDP showed that, among all women with HIV, a greater risk of mortality due to HDP was reported among those who received HAART compared with those who did not [99].…”