PMID- 28013100
OWN - NLM
STAT- MEDLINE
DCOM- 20180305
LR  - 20180305
IS  - 1872-7654 (Electronic)
IS  - 0301-2115 (Linking)
VI  - 210
DP  - 2017 Mar
TI  - The impact of highly active antiretroviral therapy on obstetric conditions: A 
      review.
PG  - 126-131
LID - S0301-2115(16)31067-3 [pii]
LID - 10.1016/j.ejogrb.2016.12.008 [doi]
AB  - HIV is the leading cause of maternal and neonatal morbidity and mortality in 
      resource constrained countries. Highly active antiretroviral treatment (HAART) 
      initiated in pregnancy has now almost eliminated mother to child transmission of 
      the virus, and is beginning to show the desired effect of reducing HIV related 
      maternal mortality. By modulating host immunological responses HAART has the 
      potential to alter infections during pregnancy, in addition to modifying clinical 
      conditions such as preeclampsia. There is increasing evidence of the benefits of 
      HAART given to pregnant women, however there is paucity of data that 
      distinguishes HIV or HAART as the cause or exacerbation of pre-existing medical 
      conditions or conditions specific to pregnancy. Anaemia is the commonest 
      haematological disorder seen in HIV infected women and is more pronounced during 
      pregnancy. The use of HAART has the potential to reduce the incidence and 
      severity of the disease. Tuberculosis (TB) is the commonest chest infection 
      amongst HIV infected people, being more common amongst pregnant than non-pregnant 
      women. It is the leading cause of death from infectious diseases amongst women of 
      reproductive age, and accounts for at least a quarter of all cases of maternal 
      deaths associated with non-pregnancy related infections (NPRI). TB can manifest 
      at any stage of the HIV infection, including during treatment with HAART. The 
      latter (ie TB manifestation during HAART treatment) is thought to be the 
      commonest manifestation of what is now known as immune reconstitution 
      inflammatory syndrome (IRIS). In a South African report on maternal deaths, 55% 
      of women who died of TB were on HAART, and a further 35% of women in the NPRI 
      category died from other pneumoniae, notably pneumocystis jorevicci, which is 
      also related to HIV infection. With regards to puerperal sepsis, studies are yet 
      to show the impact of HAART independent of antibiotics in reducing infectious 
      morbidity in HIV infected women. Preeclampsia has been associated with HIV 
      infection, where most studies point towards a reduced risk in HIV infected women. 
      There is increasing evidence that this reduced risk is reversed in the presence 
      of HAART, with women accessing HAART having almost the same risk as HIV 
      uninfected women. HIV or its treatment may be associated with increased risk of 
      obstetric haemorrhage, and an increasing trend of obstetric haemorrhage as a 
      cause of maternal deaths has been recently reported, proportionally in line with 
      the introduction and increasing availability of HAART for pregnant women The 
      mechanism by which this may occur remains elusive since pregnancy is a 
      pro-thrombotic state, however, HIV-related thrombocytopenia or vasculitis could 
      account for the association, if found. HAART would then be expected to reverse 
      this. HAART especially protease inhibitor containing combinations, have been 
      associated with preterm deliveries and low birth weight, particularly when 
      initiated prior to the index pregnancy. With these overall findings of the effect 
      of HAART on obstetric conditions, this review is intended to encourage heightened 
      surveillance of adverse events associated with HAART use in pregnant women.
CI  - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved.
FAU - Sebitloane, Hannah M
AU  - Sebitloane HM
AD  - Sebitloane Motshedisi Hannah - Discipline of Obstetrics and Gynaecology, Nelson 
      Mandela School of Medicine, College of Health Sciences, University of 
      KwaZulu-Natal, Durban, South Africa. Electronic address: sebitloanem@ukzn.ac.za.
FAU - Moodley, Dhayendre
AU  - Moodley D
AD  - Moodley Dhayendre - Women's Health and HIV Research Unit, Discipline of 
      Obstetrics and Gynaecology, Nelson Mandela School of Medicine, College of Health 
      Sciences, University of KwaZulu-Natal, Durban, South Africa.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20161209
PL  - Ireland
TA  - Eur J Obstet Gynecol Reprod Biol
JT  - European journal of obstetrics, gynecology, and reproductive biology
JID - 0375672
SB  - IM
MH  - Antiretroviral Therapy, Highly Active/*adverse effects
MH  - Female
MH  - HIV Infections/*drug therapy
MH  - Humans
MH  - Pregnancy
MH  - Pregnancy Complications, Infectious/*drug therapy
OTO - NOTNLM
OT  - HAART
OT  - Maternal and fetal outcomes
OT  - Obstetric conditions
EDAT- 2016/12/26 06:00
MHDA- 2018/03/06 06:00
CRDT- 2016/12/26 06:00
PHST- 2016/09/20 00:00 [received]
PHST- 2016/12/01 00:00 [revised]
PHST- 2016/12/08 00:00 [accepted]
PHST- 2016/12/26 06:00 [pubmed]
PHST- 2018/03/06 06:00 [medline]
PHST- 2016/12/26 06:00 [entrez]
AID - S0301-2115(16)31067-3 [pii]
AID - 10.1016/j.ejogrb.2016.12.008 [doi]
PST - ppublish
SO  - Eur J Obstet Gynecol Reprod Biol. 2017 Mar;210:126-131. doi: 
      10.1016/j.ejogrb.2016.12.008. Epub 2016 Dec 9.