Browne Joyce L, Schrier Verena J M M, Grobbee Diederick E, Peters Sanne A E, Klipstein-Grobusch Kerstin
*Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; †The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; and ‡Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Acquir Immune Defic Syndr. 2015 Sep 1;70(1):91-8. doi: 10.1097/QAI.0000000000000686.
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.
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.
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.
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.
有数据表明，感染艾滋病毒或使用高效抗逆转录病毒疗法会增加妊娠期高血压疾病的风险。本系统评价和荟萃分析旨在概述迄今为止的相关研究。
对EMBASE、PubMed和Cochrane图书馆数据库进行系统评价，以获取关于妊娠期艾滋病毒和/或艾滋病毒治疗与发生妊娠高血压（PIH）、先兆子痫、子痫或溶血肝酶升高血小板减少综合征风险之间关联的文章。使用经过改编的Cochrane协作偏倚评估工具对文章质量进行评估。相对风险（RRs）采用随机效应荟萃分析合并，权重为方差的倒数。
在筛选的2136篇文章中，28项研究符合纳入标准；15项研究报告了与PIH的关联，16项报告了与先兆子痫的关联，5项报告了与子痫的关联，3篇文章报告了艾滋病毒治疗方案。所有文章都有较高的偏倚风险，研究间异质性较大。基于荟萃分析，艾滋病毒与PIH[RR 1.26，95%置信区间（CI）：0.87至1.83，I = 78.6%]、先兆子痫（RR 1.01，95%CI：0.87至1.18，I = 63.9%）或子痫（RR 1.61，95%CI：0.14至18.68，I = 97.0%）之间似乎没有关联。无法对艾滋病毒治疗与妊娠期高血压疾病风险的关联进行荟萃分析。
这项荟萃分析表明，艾滋病毒阳性与PIH、先兆子痫或子痫之间无显著关联。然而，大多数研究中较高的偏倚风险限制了结论的力度，需要设计良好的研究来证实或反驳这些发现。
