HIV, Antiretroviral Therapy, and Hypertensive Disorders in Pregnancy: A Systematic Review and Meta-analysis

J Acquir Immune Defic Syndr. 2015 Sep 1;70(1):91-8. doi: 10.1097/QAI.0000000000000686.


Background: There are data to suggest that infection with HIV or use of highly active antiretroviral therapy increases the risk of hypertensive disorders in pregnancy. This systematic review and meta-analysis aims to provide an overview of the research hitherto.

Methods: A systematic review of EMBASE, PubMed, and The Cochrane Library databases was conducted to obtain articles about the association between HIV in pregnancy and/or HIV therapy and the risk of developing pregnancy-induced hypertension (PIH), pre-eclampsia, eclampsia, or Hemolysis Elevated Liver enzymes Low Platelet count syndrome. Quality of articles was evaluated with an adapted Cochrane Collaboration bias assessment tool. Relative risks (RRs) were pooled with a random-effects meta-analysis weighted by the inverse of their variance.

Results: Of the 2136 articles screened, 28 studies were eligible for inclusion; 15 studies reported on the association with PIH, 16 on pre-eclampsia, 5 on eclampsia, and 3 articles on HIV therapy regimens. All articles had a high risk of bias, and between-study heterogeneity was considerable. Based on the meta-analysis, there does not seem to be an association between HIV and PIH [RR 1.26, 95% confidence interval (CI): 0.87 to 1.83, I = 78.6%], pre-eclampsia (RR 1.01, 95% CI: 0.87 to 1.18, I = 63.9%), or eclampsia (RR 1.61, 95% CI: 0.14 to 18.68, I = 97.0%). A meta-analysis of the association with HIV therapy and risk of hypertensive disorders in pregnancy could not be performed.

Conclusions: This meta-analysis shows no significant association between HIV positivity and PIH, pre-eclampsia, or eclampsia. However, the high risk of bias within most studies limits the strength of conclusions and well-designed studies are necessary to confirm or refute these findings.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Anti-Retroviral Agents / therapeutic use*
  • Eclampsia / epidemiology*
  • Female
  • HELLP Syndrome / epidemiology*
  • HIV Infections / complications*
  • HIV Infections / drug therapy*
  • Humans
  • Pre-Eclampsia / epidemiology*
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Risk Assessment


  • Anti-Retroviral Agents