Hypertensive disorders of pregnancy and HIV: analysis of a province-wide cohort during 2018 and 2019.
Hypertensive disorders of pregnancy and HIV: analysis of a province-wide cohort during 2018 and 2019.
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DOI：
10.1097/qad.0000000000003506
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发表时间：
2023-06-01
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我们评估了2018-2019年南非西开普省艾滋病毒感染者（PPHIV）中新发妊娠高血压疾病（dnHDP）的患病率，按艾滋病毒和抗逆转录病毒治疗（ART）状态进行。西开普省健康数据中心（WCPHDC）2018年1月1日至2019年12月31日期间所有有妊娠结果的人都被纳入其中。WCPHDC根据唯一标识符整合来自多个电子平台的数据。按ICD-10编码或产前140天内首次开抗高血压药对dnHDP进行分类。 患有既存高血压但未叠加先兆子痫/子痫的孕妇不被认为患有dnHDP。使用具有稳健方差的Poisson回归计算HIV/ART状态的dnHDP校正患病率（aPR）。在180553例孕妇中，13677例（7.6%）为dnHDP，33978例（18.8%）为PPHIV。在PPHIV中，11.3%（N = 3827）没有ART证据，59.7%（N = 20283）在怀孕前开始ART，29.0%（N = 9868）在怀孕期间开始ART。 与没有艾滋病毒的人相比（7.7%），在有孕前[6.9%; aPR 0.78; 95%置信区间（CI）0.74-0.83]或妊娠启动ART的PPHIV患者中，dnHDP患病率较低。（7.0%; aPR 0.83; 95% CI 0.75-0.92），未接受ART的PPHIV组较高（9.8%; aPR 1.17; 95% CI 1.06-1.29），调整了母亲年龄、多胎妊娠、多胎妊娠和既存高血压。分娩时ART持续时间至少100周与妊娠开始ART 20-<40周相比具有保护作用（aPR 0.88; 95% CI 0.78-0.98）。 在普遍抗逆转录病毒治疗的背景下，这些发现对大多数PPHIV患者来说是令人放心的。ART与dnHDP患病率增加无关，较长的ART持续时间具有保护作用。
We evaluated the prevalence of de novo hypertensive disorders of pregnancy (dnHDP) in pregnant people with HIV (PPHIV) in the Western Cape Province, South Africa in 2018–2019 by HIV and antiretroviral therapy (ART) status. All people with a pregnancy outcome from 1 January 2018 to 31 December 2019 in the Western Cape Provincial Health Data Centre (WCPHDC) were included. The WCPHDC integrates data from multiple electronic platforms according to unique identifiers. dnHDP was classified by ICD-10 code or first-time prescription of antihypertensive drugs less than 140 days before delivery. Pregnant people with preexisting hypertension without superimposed preeclampsia/eclampsia were not considered to have dnHDP. Adjusted prevalence ratios (aPR) for dnHDP by HIV/ART status were calculated using Poisson regression with robust variance. Among 180 553 pregnant people studied, 13 677 (7.6%) had dnHDP and 33 978 (18.8%) were PPHIV. Among PPHIV, 11.3% (N = 3827) had no evidence of ART, 59.7% (N = 20 283) initiated ART preconception and 29.0% (N = 9868) had ART initiated during pregnancy. Compared to those without HIV (7.7%), dnHDP prevalence was lower in PPHIV with preconception [6.9%; aPR 0.78; 95% confidence interval (CI) 0.74–0.83] or pregnancy-initiated ART (7.0%; aPR 0.83; 95% CI 0.75–0.92) and higher in PPHIV without ART (9.8%; aPR 1.17; 95% CI 1.06–1.29) adjusted for maternal age, multiparity, multigestation pregnancy and preexisting hypertension. ART duration by delivery of at least 100 weeks versus pregnancy-initiated ART of 20–<40 weeks was protective (aPR 0.88; 95% CI 0.78–0.98). In the context of universal ART, these findings are reassuring for most PPHIV. ART was not associated with increased dnHDP prevalence and longer ART duration was protective.