Effects of antiretrovirals on risk of hypertension during pregnancy

Abstract

Antiretroviral therapy (ART) with integrase inhibitors appears to increase the risk of hypertensive disorders in pregnant women, according to findings of a retrospective US study published in Obstetrics and Gynecology. Data from two pregnancy cohorts at a tertiary care hospital (Grady Memorial Hospital), including all pregnant women giving birth between 2016 and 2018, and all pregnant women with HIV giving birth between 2011 and 2018, were used to investigate the incidence of hypertensive disorder of pregnancy, gestational hypertension and preeclampsia in 80 HIV-positive versus 3464 HIV-negative women, and in 265 women with HIV receiving ART (integrase inhibitors, HIV protease inhibitors, or non-nucleoside reverse transcriptase inhibitors). There was no significant difference in the risk of hypertensive disorders of pregnancy between women with versus without HIV (29% vs 30%; adjusted risk ratio [aRR] 0.9; 95% CI 0.6, 1.3). Compared with protease inhibitor-containing regimens, integrase inhibitor-containing regimens were associated with a significantly increased risk of any hypertensive disorder of pregnancy (25% vs 10%; aRR 2.8; 95% CI 1.5, 5.1) and gestational hypertension (20% vs 8%; aRR 2.8; 95% CI 1.3, 5.9). Timing of the initiation of ART had no significant effect on the risk of hypertensive disorders of pregnancy, or on the association between ART regimens and hypertensive disorders. In summary, among women living with HIV on modern ART regimens, we observed an increased risk of hypertensive disorders of pregnancy, specifically gestational hypertension, among those on integrase strand transfer inhibitor–containing regimens compared with protease inhibitor–containing regimens, concluded the researchers. Duplication of this finding in other cohorts would indicate a need for more careful screening for hypertensive disorders of pregnancy in women on integrase strand transfer inhibitors and may warrant implementation of risk-reducing strategies, they added.