Maternal Health Implications of HIV Infection and Antiretroviral Therapy

Human immunodeficiency virus (HIV) infection in pregnancy poses a dual challenge: safeguarding maternal health while minimising vertical transmission. Without treatment, HIV can lead to immunosuppression, opportunistic infections and obstetric complications including preterm birth, small-for-gestational-age infants and stillbirth. Widespread adoption of antiretroviral therapy (ART) has transformed maternal prognosis by restoring immune competence and reducing perinatal transmission to below 2% in well-resourced settings. However, ART use in pregnancy carries its own complexities: protease inhibitor-based regimens have been linked to hepatotoxicity, while immune reconstitution under therapy may unmask inflammatory responses that contribute to endothelial dysfunction and pre-eclampsia. Dysregulated angiogenesis is a common thread, with altered levels of placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) implicating a shift towards an anti-angiogenic state. Placental histopathology in ART-exposed women frequently reveals infarction, thrombosis and syncytial abnormalities, suggesting subclinical hypoxia. Integrating epidemiological surveillance with molecular insights into angiogenic pathways and hepatic safety profiles is critical to refine antenatal monitoring, tailor ART regimens and develop adjunctive therapies. Such approaches are essential to balance the maternal benefits of viral suppression against potential drug-related risks, particularly in regions with high HIV prevalence and limited resources.

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Maternal Health Implications of HIV Infection and Antiretroviral Therapy publication trend

The graph below shows the total number of articles in maternal health implications of hiv infection and antiretroviral therapy across all publications each year (not limited to Nature Index journals).

Technical terms

Antiretroviral therapy (ART): Combination of drugs used to suppress HIV replication and restore immune function during pregnancy.

Pre-eclampsia: Pregnancy-specific hypertensive disorder characterised by new-onset high blood pressure and organ dysfunction after 20 weeks of gestation.

Angiogenic factors: Molecules such as placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) that regulate placental blood vessel formation and function.

Hepatotoxicity: Liver injury or dysfunction induced by chemical agents, including certain antiretroviral drugs, detectable via elevated serum enzymes.

Immune reconstitution: Restoration of immune cell populations and function following suppression of HIV replication by ART, which may influence inflammatory responses in pregnancy.

References

1. The Impact of Antiretroviral Therapy on Liver Function Among Pregnant Women Living with HIV in Co-Existence with and Without Pre-Eclampsia. Viruses (2024).
2. Altered angiogenesis as a common mechanism underlying preterm birth, small for gestational age, and stillbirth in women living with HIV. American Journal of Obstetrics and Gynecology (2017).
3. No association between early antiretroviral therapy during pregnancy and plasma levels of angiogenic factors: a cohort study. BMC Pregnancy and Childbirth (2019).
4. Vascular Endothelial Growth Factor Receptor 2: Molecular Mechanism and Therapeutic Potential in Preeclampsia Comorbidity with Human Immunodeficiency Virus and Severe Acute Respiratory Syndrome Coronavirus 2 Infections. International Journal of Molecular Sciences (2022).