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Imogie SA, Sebitloane HM. Influence of HIV and its treatment on hypertensive disorders of pregnancy in women from a low- to middle-income country. Int J Gynaecol Obstet 2023. [PMID: 36825507 DOI: 10.1002/ijgo.14731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/18/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To establish a potential relationship between hypertensive disorders of pregnancy (HDP) and HIV infection. METHODS This cross-sectional observational study involving 300 women with HDP was undertaken from September 2018 to February 2019 in a regional hospital in Durban, South Africa, a setting with a background HIV prevalence of 45% among pregnant women. All women with new-onset elevation of blood pressure after the 20th week of pregnancy were enrolled and, following informed consent, the relevant information was extracted from their files. RESULTS Of the 300 women with HDP, the HIV prevalence was 30%, compared with the historical seroprevalence of 45% within the hospital (P = 0.028). For all categories of HDP, there were fewer primigravid women among women living with HIV (WLHIV), compared with those uninfected (30% vs 50.2%, respectively; P = 0.001). HDP developed later in gestation in WLHIV compared with uninfected women (32.6 weeks vs 34 weeks, respectively; P = 0.023), however, there were significant maternal complications of abruption and elevated liver enzymes among WLHIV (P = 0.02 and P = 0.014, respectively). Despite this, the perinatal outcomes were similar in both groups. CONCLUSION HIV or its treatment seems to have a protective effect in the development of HDP; however, the complications of HDP may be significant in WLHIV receiving treatment.
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Affiliation(s)
- S A Imogie
- Discipline of Obstetrics and Gynaecology, King Edward VIII Hospital and Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - H M Sebitloane
- Discipline of Obstetrics and Gynaecology, King Edward VIII Hospital and Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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2
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Abel T, Moodley J, Khaliq OP, Naicker T. 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. Int J Mol Sci 2022; 23:ijms232213752. [PMID: 36430232 PMCID: PMC9691176 DOI: 10.3390/ijms232213752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
This review explored the role of vascular endothelial growth factor receptor-2 (VEGFR-2) in the synergy of preeclampsia (PE), human immunodeficiency virus (HIV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Downregulation of VEGFR-2 in PE promotes endothelial dysfunction and prevents endothelial cell (EC) migration, proliferation, and differentiation. The HIV-1 accessory protein, tat (trans-activator of transcription), prevents VEGFR-2 signaling via the vascular endothelial growth factor A (VEGF-A) ligand. Combined antiretroviral therapy (cART) may cause immune reconstitution, impaired decidualization, and endothelial injury, thus may be a risk factor for PE development. The VEGF/VEGFR-2 interaction may be associated with SARS-CoV-2-related pulmonary oedema. Endothelial dysfunction and heightened inflammation are both associated with PE, HIV, and SARS-CoV-2 infection; therefore, it is plausible that both characteristics may be exacerbated in the synergy of these events. In addition, this review explored microRNAs (miR) regulating VEGFR-2. An overexpression of miR-126 is evident in PE, HIV, and SARS-CoV-2 infection; thus, modulating the expression of miR-126 may be a therapeutic strategy. However, the involvement of microRNAs in PE, HIV, and SARS-CoV-2 infection needs further investigating. Since these conditions have been evaluated independently, this review attempts to predict their clinical manifestations in their synergy, as well as independently; thereby providing a platform for early diagnosis and therapeutic potential in PE, HIV, and SARS-CoV-2 infection.
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Affiliation(s)
- Tashlen Abel
- Women’s Health and HIV Research Group, Department of Obstetrics & Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Jagidesa Moodley
- Women’s Health and HIV Research Group, Department of Obstetrics & Gynaecology, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Olive P. Khaliq
- Department of Paediatrics and Child Health, Faculty of Health Sciences, The University of the Free State, Bloemfontein 9300, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, Doris Duke Medical Research Institution, College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
- Correspondence:
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Wang X, Carcel C, Woodward M, Schutte AE. Blood Pressure and Stroke: A Review of Sex- and Ethnic/Racial-Specific Attributes to the Epidemiology, Pathophysiology, and Management of Raised Blood Pressure. Stroke 2022; 53:1114-1133. [PMID: 35344416 DOI: 10.1161/strokeaha.121.035852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Raised blood pressure (BP) is the leading cause of death and disability worldwide, and its particular strong association with stroke is well established. Although systolic BP increases with age in both sexes, raised BP is more prevalent in males in early adulthood, overtaken by females at middle age, consistently across all ethnicities/races. However, there are clear regional differences on when females overtake males. Higher BP among males is observed until the seventh decade of life in high-income countries, compared with almost 3 decades earlier in low- and middle-income countries. Females and males tend to have different cardiovascular disease risk profiles, and many lifestyles also influence BP and cardiovascular disease in a sex-specific manner. Although no hypertension guidelines distinguish between sexes in BP thresholds to define or treat hypertension, observational evidence suggests that in terms of stroke risk, females would benefit from lower BP thresholds to the magnitude of 10 to 20 mm Hg. More randomized evidence is needed to determine if females have greater cardiovascular benefits from lowering BP and whether optimal BP is lower in females. Since 1990, the number of people with hypertension worldwide has doubled, with most of the increase occurring in low- and-middle-income countries where the greatest population growth was also seen. Sub-Saharan Africa, Oceania, and South Asia have the lowest detection, treatment, and control rates. High BP has a more significant effect on the burden of stroke among Black and Asian individuals than Whites, possibly attributable to differences in lifestyle, socioeconomic status, and health system resources. Although pharmacological therapy is recommended differently in local guidelines, recommendations on lifestyle modification are often very similar (salt restriction, increased potassium intake, reducing weight and alcohol, smoking cessation). This overall enhanced understanding of the sex- and ethnic/racial-specific attributes to BP motivates further scientific discovery to develop more effective prevention and treatment strategies to prevent stroke in high-risk populations.
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Affiliation(s)
- Xia Wang
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia
| | - Cheryl Carcel
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,Sydney School of Public Health, Sydney Medical School, The University of Sydney, New South Wales, Australia (C.C.)
| | - Mark Woodward
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,The George Institute for Global Health, School of Public Health, Imperial College London, United Kingdom (M.W.)
| | - Aletta E Schutte
- The George Institute for Global Health (X.W., C.C., M.W., A.E.S.), University of New South Wales, Sydney, Australia.,School of Population Health (A.E.S.), University of New South Wales, Sydney, Australia.,Hypertension in Africa Research Team, Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
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4
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Nkeh-Chungag BN, Engwa GA, Businge C, Kutllovci-Hasani K, Kengne AP, Goswami N. Assessment of the Cardiovascular Risk Profile of Infants Exposed to Pre-eclampsia in-utero: A Prospective Case-Control Study in South African Children of African Ancestry. Front Cardiovasc Med 2021; 8:773841. [PMID: 34888368 PMCID: PMC8650009 DOI: 10.3389/fcvm.2021.773841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: It has been reported that maternal gestational environment may be programmed to have a significant impact on foetal and offspring health later in life. Studies have shown that children born to pre-eclamptic mothers are prone to obesity, hypertension, and diabetes in their adult life. However, such findings are yet to be established in an African population. This protocol is for a study aiming to investigate the relationship between pre-eclampsia (PE) and cardiovascular risk in children born to pre-eclamptic mothers in a South African population of African descents. Methods: A prospective case-control design will be employed to recruit pre-eclamptic and normotensive pregnant women and their offspring after birth. Pregnant women will be assessed for cardiovascular risk factors including PE, obesity, haemodynamics, lipids, glycaemic indices, oxidative stress, and vascular function at 30 weeks of gestation. The cardiovascular risk profile of their offspring will be assessed at birth and 6 weeks later. The difference in cardiovascular risk profile between children born to the pre-eclamptic and normotensive mothers will be compared and the correlation between maternal and offspring cardiovascular risks will be investigated. Discussion: This will be the first prospective study to assess the in-utero effect of cardiovascular risk in offspring born to pre-eclamptic women of African ancestry. It is expected that findings from this study will provide information on the cardiovascular effect of in-utero exposure to PE in a population of African ancestry. This knowledge will advise policy on the management of women with PE with a view of protecting cardiovascular health in offspring.
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Affiliation(s)
- Benedicta Ngwenchi Nkeh-Chungag
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, South Africa
| | - Godwill Azeh Engwa
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, South Africa
| | - Charles Businge
- Department of Obstetrics and Gynaecology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, South Africa
| | | | - Andre P Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nandu Goswami
- Department of Biological and Environmental Sciences, Faculty of Natural Sciences, Walter Sisulu University PBX1, Mthatha, South Africa.,Physiology Division, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria.,College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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5
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Ramdin T, Radomsky M, Raxendis C, Devchand T, Morris C, Sekgota C, Stols L, Mokhachane M. A Review of Very-Low-Birth-Weight Infants Admitted to the Kangaroo Mother Care Unit in Johannesburg, South Africa. Cureus 2021; 13:e20428. [PMID: 35047265 PMCID: PMC8759983 DOI: 10.7759/cureus.20428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/26/2022] Open
Abstract
Background Kangaroo Mother Care (KMC) is a widely implemented intervention developed as an alternative form of care in low- and middle-income countries (LMICs) for neonates. The implementation of KMC has significantly reduced morbidity and mortality in very-low-birth-weight infants (VLBWIs). Aim To describe the maternal and neonatal characteristics and clinical outcomes in VLBWIs who received KMC at a tertiary hospital. Methods This is a retrospective descriptive study of 981 VLBWIs admitted at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) over a six-year period (January 1, 2014, to December 31, 2019). Results The mean gestational age of infants admitted to the unit was 29.6 weeks (standard deviation (SD): 2.4), with a mean birth weight of 1185 g (SD: 205.6). The average duration of admission in the neonatal unit was 37 days. The mean rate of weight gain was 37.6 g/kg/day (SD: 57.6). The majority of infants were breastfed (61.4%). In our study, the prevalences of the complications of prematurity were as follows: respiratory distress syndrome (RDS), 84.2%; late-onset sepsis (LOS), 26.1%; and retinopathy of prematurity (ROP), 10.6%. The mortality rate was 3.1%. Maternal comorbidities include human immunodeficiency virus (HIV) (26.4%), syphilis (2.9%) and gestational hypertension (33.7%). The antenatal clinic attendance rate was good (84.7%). Conclusion KMC is a cost-effective alternative to conventional care for VLBWIs in limited-resource countries, with evidence of increased weight gain, less rates of complications of prematurity and low overall mortality. The provision of KMC facilities is urgently required in LMICs.
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Affiliation(s)
- Tanusha Ramdin
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Michael Radomsky
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Christina Raxendis
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Tejis Devchand
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Cassady Morris
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Charmaine Sekgota
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Lorenzo Stols
- Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, ZAF
| | - Mantoa Mokhachane
- Unit for Undergraduate Medical Education, University of the Witwatersrand, Johannesburg, ZAF
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6
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Singh S, Moodley J, Khaliq OP, Naicker T. A Narrative Review of the Renin-Angiotensin-Aldosterone System in the Placenta and Placental Bed of HIV Infected Women of African Ancestry with Preeclampsia. Curr Hypertens Rep 2021; 23:39. [PMID: 34415457 PMCID: PMC8377458 DOI: 10.1007/s11906-021-01158-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Both HIV infection and preeclampsia (PE), a pregnancy-specific disorder of hypertension and multi-system organ involvement, have high prevalence rates especially in low-to-middle-income countries. The immunoexpression of specific renin-angiotensin-aldosterone system (RAAS) receptors in the placenta and placental bed interface may forecast the risk of PE. RECENT FINDINGS Preeclampsia is a leading risk factor for mortality worldwide and remains a challenge in HIV-infected individuals especially those on antiretroviral therapy (ART). Irregular RAAS stimulation may be linked to the pathophysiology of hypertension in HIV infection and in PE. The AT1 receptor is expressed across all trimesters of pregnancy, within placental tissue, eliciting vasoconstriction. This increased expression is associated with the severity of PE, implying that the increased expression may be involved in the pathogenesis of this pregnancy disorder. The AT2 receptor expression in normotensive pregnancies was shown to be lower as compared to non-pregnant individuals. Furthermore, in the PE placental bed, the AT2 receptor is the predominant receptor subtype and is found in extravillous trophoblast cells where they facilitate vasodilation. However, AT4R in placentae of PE pregnancies are found to be significantly reduced compared to normotensives pregnancies. The data on the role played by the RAAS pathway in pregnancy is conflicting. Investigation into a tissue-based RAAS with emphasis on immune-expression within the placenta and placental bed may help resolve this conundrum.
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Affiliation(s)
- Shoohana Singh
- grid.16463.360000 0001 0723 4123Optics and Imaging Centre, Doris Duke Medical Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- grid.16463.360000 0001 0723 4123Department of Obstetrics and Gynaecology, Women’s Health and HIV Research Group, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Olive Pearl Khaliq
- grid.16463.360000 0001 0723 4123Department of Obstetrics and Gynaecology, Women’s Health and HIV Research Group, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Thajasvarie Naicker
- grid.16463.360000 0001 0723 4123Optics and Imaging Centre, Doris Duke Medical Research Institute, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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7
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Ngene NC, Moodley J. Postpartum blood pressure patterns in severe preeclampsia and normotensive pregnant women following abdominal deliveries: a cohort study. J Matern Fetal Neonatal Med 2020; 33:3152-3162. [PMID: 30700189 PMCID: PMC7193714 DOI: 10.1080/14767058.2019.1569621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/24/2018] [Accepted: 01/10/2019] [Indexed: 01/19/2023]
Abstract
Objective: To determine blood pressure (BP) patterns in the immediate postpartum period in preeclampsia with severe features (sPE) and normotensive pregnant women who had cesarean deliveries (CD).Study design: The BP levels of two groups comprising 50 sPE and 90 normotensive pregnant women who had CD were measured before delivery and on days 0-3 postpartum at four time points (05:00, 08:00, 14:00, and 22:00). Soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PIGF) were measured in the maternal serum ≤48 h before delivery.Results: Antihypertensive therapy was administered to 98, 96, 82, 78, and 56% of sPE antepartum and on postpartum days 0-3, respectively. De novo postpartum hypertension (BP ≥ 140/90 mmHg) occurred in 24.4% (22/90) of the normotensive group but only one required antihypertensive therapy. The occurrence of de novo postpartum hypertension was associated with maternal weight before delivery ≥ 84.5 kg (relative risks (RR) 2.6, CI 95% 1.2-5.8, p = .017), and body mass index before delivery ≥ 33.3 kg/m2 (RR 2.9, CI 95% 1.3-6.4, p = .008). In sPE, the BP decreased between predelivery period and postpartum day 0. From days 1 to 3 postpartum, there was a continuous increase in the daily mean BPs in both groups, with average daily increments (systolic/diastolic) being 5.6/4.6 mmHg and 0.6/1.3 mmHg in the sPE and normotensive women, respectively. Patient's group and time had a significant effect on BP, p < .001. Overall, daily mean BPs were higher in the sPE than the normotensive group (p < .001). Perceived stress (p = .022), low birth weight (p = .002), 5 min Apgar score ≤ 6 (p < .001) were significantly higher in the sPE group. sFlt-1/PIGF ratio was high in the hypertensive groups: sPE versus normotensive group, p < .001; de novo postpartum hypertension versus normotensives group that remained normotensive, p = .102.Conclusion: Postpartum BP and antihypertensive requirements are important considerations in managing sPE and normotensive pregnancies. sPE is associated with increased maternal stress and poor perinatal outcomes.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynaecology, University of KwaZulu-Natal, Durban, South Africa
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8
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The role of LNPEP and ANPEP gene polymorphisms in the pathogenesis of pre-eclampsia. Eur J Obstet Gynecol Reprod Biol 2020; 252:160-165. [PMID: 32619880 DOI: 10.1016/j.ejogrb.2020.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The exact role of renin angiotensin system (RAS) in the pathogenesis of pre-eclampsia has not been established. Gene polymorphisms, however, have been implicated in the pathophysiology. Therefore, the aim of this study was to investigate the association of the Angiotensin IV receptor and aminopeptidase-N in the pathogenesis of pre-eclampsia. STUDY DESIGN Stored blood samples of 637 South African women of African ancestry were utilized. The study population was divided into controls (n = 280) and pre-eclampsia (n = 357). Pre-eclampsia was sub-divided into early (n = 187) and late (n = 170) onset subtypes. DNA was extracted from whole blood and genotyped. Odds ratio and 95 % confidence intervals were used to assess the association. RESULTS The allele and genotype frequencies of the angiotensin receptor IV and aminopeptidase-N showed no significant difference between the control versus the pre-eclampsia groups. Similarly, allele and genotype distributions of the control group versus the subtypes of pre-eclampsia (early onset and late onset pre-eclampsia) showed no significant differences. CONCLUSION The single nucleotide polymorphisms of angiotensin IV receptor (rs18059) and aminopeptidase-N (rs6496603) are not associated with the pathogenesis of pre-eclampsia in women of African ancestry.
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Phoswa WN, Ramsuran V, Naicker T, Singh R, Moodley J. HLA-G Polymorphisms Associated with HIV Infection and Preeclampsia in South Africans of African Ancestry. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1697657. [PMID: 32596279 PMCID: PMC7305545 DOI: 10.1155/2020/1697657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/04/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES HLA-G, part of the major histocompatibility complex (MHC), is associated with the risk of developing preeclampsia (PE). In this study, we determined the contribution of specific HLA-G polymorphisms on the risk of developing preeclampsia in HIV-infected and uninfected South Africans of African ancestry. METHODS One hundred and ninety-three women of African ancestry were enrolled (74 HIV-uninfected normotensive, 60 HIV-infected normotensive, 34 HIV-uninfected, and 25 HIV-infected preeclamptics). Sanger sequencing of the untranslated region was performed to genotype six SNPs, i.e., 14 bp Ins/Del of rs66554220, rs1710, rs1063320, rs1610696, rs9380142, and rs1707). RESULTS For rs66554220, we have the following results: (a) based on pregnancy type-the Ins/Ins and Del/Ins genotype frequency was higher in preeclampsia (PE) compared to normotensive pregnancies (Ins/Ins vs. Del/Ins, P = 0.02∗: OR (95%CI) = 13.44 (0.7222-249.9); Del/Del vs. Del/Ins, P = 0.03∗: OR (95%CI) = 2.95 (1.10-7.920)); (b) based on HIV status-the Ins/Ins showed both genotypic and allelic association with HIV infection. HIV-infected PE has higher Ins/Ins genotypic and allelic frequencies compared to HIV-uninfected PE (Ins/Ins vs. Del/Ins, P = 0.005∗∗: OR (95%CI) = 21.32 (1.71-4.17); Ins, P = 0.005∗∗; OR (95%IC) = 21.32 (1.71-4.17)). For rs1707, we have the following results: (a) based on pregnancy type-there were CT genotypic frequencies in PE, more especially LOPE compared to normotensive pregnancies (TT vs. CT, P = 0.0092∗∗: OR (95%CI) = 5.(1.39 - 25.64)), and no allelic association was noted; (b) based on HIV status-CT was higher in HIV-infected LOPE compared to uninfected LOPE (TT vs. TC, P = 0.0006∗∗∗: OR (95%CI) = 40.00 (2.89 - 555.1)). For rs1710 and rs1063320, no significant differences in the genotype and allele frequencies were noted based on pregnancy type and HIV status. For rs9380142, we have the following results: (a) based on pregnancy type-no significant differences were noted between normotensive compared to PE pregnancies; (b) based on HIV status-AA genotypes occurred more in the HIV-infected PE group (AA vs. GG, P = 0.02∗: OR (95%CI) = 13.97 (0.73 - 269.4)), while A allelic frequency occurred more in HIV-infected PE, especially LOPE compared to uninfected groups (A vs. G, P = 0.0003∗∗∗: OR (95%CI) = 10.72 (2.380 - 48.32); P = 0.02∗: OR (95%CI) = 9.00 (1.07 - 75.74)). For rs1610696, we have the following results: (a) based on pregnancy type-genotypic and allelic frequencies of CC were higher in PE compared to normotensive pregnancies (CC vs. GG, P = 0.0003∗∗∗: OR (95%CI) = 31.87 (1.861 - 545.9); C, P = 0.0001∗∗∗: OR (95%IC) = 21.91 (2.84 - 169.0)); (b) based on HIV status-GG frequencies were higher in the HIV-infected PE more especially LOPE groups (GG vs. GC, P = 0.02∗: OR (95%CI) = 16.87 (0.81 - 352.1); GG vs. CC, P = 0.0001∗∗∗: OR (95%CI) = 159.5 (13.10 - 1942)). CONCLUSION Selected HLA-G 14 bp polymorphisms (Ins/Ins) and genotypic and allelic differences in rs9380142, rs1610696, and rs1707 are associated with the pathogenesis of preeclampsia in HIV-infected South African women of African ancestry. More genetic studies evaluating the association between preeclampsia and HIV infection are needed to improve diagnosis and antenatal care.
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Affiliation(s)
- Wendy N. Phoswa
- Discipline of Obstetrics and Gynecology, Nelson R. Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Veron Ramsuran
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, University of KwaZulu-Natal, Durban, South Africa
| | - Ravesh Singh
- Department of Microbiology, National Health Laboratory Services, KwaZulu-Natal Academic Complex, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, University of KwaZulu-Natal, Durban, South Africa
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10
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Idris H, Duum NCN, Adamu UG, Abdullateef RM, Yabagi IA. Hypertensive Disorders in Pregnancy: Pattern and Obstetric Outcome in Bida, Nigeria. Niger Med J 2020; 61:42-47. [PMID: 32317821 PMCID: PMC7113814 DOI: 10.4103/nmj.nmj_29_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 06/20/2019] [Accepted: 09/11/2019] [Indexed: 11/11/2022] Open
Abstract
Context: Cases of hypertensive disorders in pregnancy (HDP) are an increase in developing economies. Identifying the pattern of HDP in a particular community and documenting their management outcome may allow for proper planning by all stakeholders. Aims: The objective was to determine the pattern and management outcome of hypertensive disorders among pregnant women. Settings and Design: This was a prospective cohort study involving 183 consecutive cases of HDP at Federal Medical Centre, Bida, Niger State, Nigeria, between September 2015 and August 2016. Subjects and Methods: Pregnant women with hypertension were recruited and managed according to the departmental protocol. They were followed up till 6 weeks after delivery; fetal and maternal outcomes were documented. Statistical Analysis Used: Data were analyzed using the SPSS software version 23. The level of statistical significance was set at P < 0.05. Results: A total of 1956 deliveries occurred during the study with 183 cases of HDP, giving an incidence of 9.4%. Pregnancy-induced hypertension alongside preeclampsia constitutes the majority of HDP during the study and had accounted for over 64%. Women who did not receive antenatal care in our center were at significantly greater risk of eclampsia (P = 0.000), abruption placentae (P = 0.003), maternal death (P = 0.002), very low-birth-weight (LBW) babies (P = 0.002), extremely LBW babies (P = 0.03), and perinatal death (P = 0.000). Conclusion: The need for prenatal screening that enables the early identification and prompt management of all expectant mothers with HDP is advised.
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Affiliation(s)
- Haruna Idris
- Department of Obstetrics and Gynaecology, Federal Medical Centre, Bida, Niger State, Nigeria
| | | | - Umar Gati Adamu
- Department of Internal Medicine, Federal Medical Centre, Bida, Niger State, Nigeria
| | | | - Isah Aliyu Yabagi
- Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja, Nigeria
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Gemechu KS, Assefa N, Mengistie B. Prevalence of hypertensive disorders of pregnancy and pregnancy outcomes in Sub-Saharan Africa: A systematic review and meta-analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2020; 16:1745506520973105. [PMID: 33334273 PMCID: PMC7750906 DOI: 10.1177/1745506520973105] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/22/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
Hypertensive disorders of pregnancy are one of the leading causes of poor pregnancy outcomes and are associated with increased rates of maternal mortality, preterm birth, small for gestational age newborns, stillbirth, and neonatal death. The overall and type-specific prevalence of hypertensive disorders of pregnancy and associated pregnancy outcomes are unknown in Sub-Saharan Africa. Therefore, this review aimed to identify the prevalence of hypertensive disorders of pregnancy and associated pregnancy outcomes in Sub-Saharan Africa. A systematic review and meta-analysis were conducted on observational facility-based studies irrespective of publication status, sample size, language, and follow-up duration from 19 countries between the years 2000 and 2018 in Sub-Saharan Africa. A review of studies using PubMed, EMBASE, African Index Medicus, and African Journals Online was completed with independent extraction of studies by review authors using the predefined inclusion criteria. Quality and risk of bias of individual studies were assessed using the Joanna Briggs Institute Checklist. Random effects model was used to estimate the pooled prevalence of hypertensive disorders of pregnancy and type-specific hypertensive disorders of pregnancy. A pooled adjusted odds ratio with 95% confidence interval for each study was calculated using comprehensive meta-analysis version 2 software to estimate the association of hypertensive disorders of pregnancy and its outcomes. The existence of heterogeneity was assessed using I2 and its corresponding P value. We assessed the presence of publication bias using the Egger's test. Subgroup analysis was performed to assess the potential effect of variables, and a sensitivity analysis was conducted to assess any undue influence from studies. The analysis included 70 studies. The pooled prevalence of hypertensive disorders of pregnancy (all types combined), chronic hypertension, gestational hypertension, preeclampsia, and eclampsia were 8% (95% confidence interval = [5, 10]), 0.9% (95% confidence interval = [0.4, 1.8]), 4.1% (95% confidence interval = [2.4, 7]), 4.1% (95% confidence interval = [3.2, 5.1]), and 1.5% (95% confidence interval = [1, 2]), respectively. Compared with normotensive pregnant or postpartum women, women with hypertensive disorders of pregnancy were associated with increased risk of maternal mortality, odds ratio = 17 (95% confidence interval = [9.6, 28.8]); cesarean section, odds ratio = 3.1 (95% confidence interval = [1.7, 5.6]); perinatal mortality, odds ratio = 8.2 (95% confidence interval = [2.8, 24]); low birth weight, odds ratio = 3.2 (95% confidence interval = [2, 5]); and preterm delivery, odds ratio = 7.8 (95% confidence interval = [2.5, 25.3]) according to this analysis. The pooled prevalence of hypertensive disorders of pregnancy was high in Sub-Saharan Africa compared to those reported from other regions. Pregnant or postpartum women with hypertensive disorders of pregnancy have increased risk of maternal mortality, cesarean section, preterm delivery, perinatal mortality, and low birth weight newborn. Therefore, creating awareness of the risks of hypertensive disorders of pregnancy is essential. Pregnant women with hypertensive disorders need due attention to manage appropriately and more importantly to have favorable outcomes in this population.
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Affiliation(s)
- Kasiye Shiferaw Gemechu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Nega Assefa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengistie
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Naidoo Y, Moodley J, Ramsuran V, Naicker T. Polymorphisms within vitamin D binding protein gene within a Preeclamptic South African population. Hypertens Pregnancy 2019; 38:260-267. [PMID: 31559882 DOI: 10.1080/10641955.2019.1667383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Objectives: The vitamin D binding protein encoded by the GC gene contains two single nucleotide polymorphisms (rs4588 and rs7041) that have been associated with disease outcome, these include periodontitis coronary heart disease and hypertension. In pregnancy, these SNPs influence vitamin D metabolism that could result in hypertensive disorders such as PE. The etiology of PE, still remains elusive. The aim of this study was to evaluate the distribution of rs4588 and rs7041 within the GC gene among PE and normotensive pregnant women, residing in Durban, KwaZulu-Natal, South Africa. Study design: Our study consisted of n = 600 participants (normotensive (n = 246, N); early onset PE (n = 167, EOPE); and late-onset PE (n = 246, LOPE)). We extracted DNA from whole blood and genotyped for rs4588 and rs7041 SNPs using the TaqMan assay. Results: Regardless of HIV status, we observed the rs4588 (CC genotype) more frequently in PE (EOPE+LOPE) compared to the normotensive participants with an OD ratio of 0.74 (95% CI, 0.35-1.5; p < 0.001). We report a significant difference in the frequency of rs7041 (GT genotype) in the EOPE group compared to the normotensive group with an OD ratio of 11.48 (95% CI, 2.6-103.7; p < 0.001). The rs7041 GT genotype had a higher frequency in the EOPE compared to the LOPE group, with an OD ratio of 15.15 (95% CI, 2.3-639.2; p < 0.001). Conclusion: This is the first study to describe the prevalence of SNPs of the rs4588 and rs7041 within the GC gene in women with PE within the high HIV endemic area of KZN, South Africa. Notably, a significant association of the rs7041 (TT genotype) and rs4588 (CC genotype) occurred at a higher frequency in PE compared to the normotensive cohort. Future studies will examine the functional effect of the GC region in relation to pregnancy and vitamin D deficiency.
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Affiliation(s)
- Yeshnee Naidoo
- Discipline of Optics and Imaging, Women's Health and HIV Research Group , Durban , South Africa
| | - Jagidesa Moodley
- KZN Research Innovation and Sequencing Platform, University of KwaZulu-Natal , Durban , South Africa
| | - Veron Ramsuran
- KwaZulu-Natal Research and Innovation Sequencing Platform, University of KwaZulu-Natal Nelson R Mandela School of Medicine , Durban , South Africa
| | - Thajasvarie Naicker
- Department of Optics and Imaging, University of KwaZulu-Natal , Durban , South Africa
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Naicker T, Phoswa WN, Onyangunga OA, Gathiram P, Moodley J. Angiogenesis, Lymphangiogenesis, and the Immune Response in South African Preeclamptic Women Receiving HAART. Int J Mol Sci 2019; 20:ijms20153728. [PMID: 31366152 PMCID: PMC6696390 DOI: 10.3390/ijms20153728] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/15/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
Purpose of the review: This review highlights the role of angiogenesis, lymphangiogenesis, and immune markers in human immunodeficiency virus (HIV)-associated preeclamptic (PE) pregnancies in an attempt to unravel the mysteries underlying the duality of both conditions in South Africa. Recent findings: Studies demonstrate that HIV-infected pregnant women develop PE at a lower frequency than uninfected women. In contrast, women receiving highly active anti-retroviral therapy (HAART) are more inclined to develop PE, stemming from an imbalance of angiogenesis, lymphangiogenesis, and immune response. Summary: In view of the paradoxical effect of HIV infection on PE development, this study examines angiogenesis, lymphangiogenesis, and immune markers in the highly HIV endemic area of KwaZulu-Natal. We believe that HAART re-constitutes the immune response in PE, thereby predisposing women to PE development. This susceptibility is due to an imbalance in the angiogenic/lymphangiogenic/immune response as compared to normotensive pregnant women. Further large-scale studies are urgently required to investigate the effect of the duration of HAART on PE development.
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Affiliation(s)
- Thajasvarie Naicker
- Optics and Imaging Centre, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban 4013, South Africa.
| | - Wendy N Phoswa
- Discipline of Obstetrics and Gynecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban 4013, South Africa.
| | - Onankoy A Onyangunga
- Optics and Imaging Centre, Doris Duke Medical Research Institute, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Premjith Gathiram
- Women's Health and HIV Research Group. Department of Obstetrics and Gynecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban 4013, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group. Department of Obstetrics and Gynecology, School of Clinical Medicine, University of KwaZulu-Natal, Durban 4013, South Africa
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Alese OM, Naicker T, Moodley J. Liver enzyme patterns in maternal deaths due to eclampsia: A South African cohort. Pregnancy Hypertens 2019; 17:15-19. [DOI: 10.1016/j.preghy.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/20/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Pillay Y, Moodley J, Naicker T. The role of the complement system in HIV infection and preeclampsia. Inflamm Res 2019; 68:459-469. [PMID: 31028431 DOI: 10.1007/s00011-019-01240-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The complement system is a key component of the innate immune system that plays a vital role in host defense, maintains homeostasis and acts as a mediator of the adaptive immune response. The complement system could possibly play a role in the pathogenesis of HIV infection and preeclampsia (PE), both of which represent major causes of maternal death in South Africa. RECENT FINDINGS The relationship between PE and HIV infection is unclear as PE represents an exaggerated immune response, while HIV infection is associated with a decline in immune activity. Although the complement system works to clear and neutralize HIV, it could also enhance the infectivity of HIV by various other mechanisms. It has been suggested that the dysregulation of the complement system is associated with the development of PE. CONCLUSION There is currently a paucity of information on the combined effect of the complement system in HIV-associated PE. This review highlights the role of the complement system in the duality of HIV infection and PE and provides new insights into this relationship whilst also elucidating potential therapeutic targets.
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Affiliation(s)
- Yazira Pillay
- Optics and Imaging Centre, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Thajasvarie Naicker
- Optics and Imaging Centre, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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Ngene NC, Moodley J, Naicker T. The performance of pre-delivery serum concentrations of angiogenic factors in predicting postpartum antihypertensive drug therapy following abdominal delivery in severe preeclampsia and normotensive pregnancy. PLoS One 2019; 14:e0215807. [PMID: 31022243 PMCID: PMC6485032 DOI: 10.1371/journal.pone.0215807] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 04/09/2019] [Indexed: 01/07/2023] Open
Abstract
Background The imbalance between circulating concentrations of anti- and pro-angiogenic
factors is usually intense in preeclampsia with severe features (sPE). It is
possible that pre-delivery circulating levels of angiogenic factors in sPE
may be associated with postpartum antihypertensive drug requirements. Objective To determine the predictive association between maternal pre-delivery serum
concentrations of angiogenic factors and the use of ≥3 slow- and/or a
rapid-acting antihypertensive drug therapy in sPE on postpartum days zero to
three following caesarean delivery. Study design Women with sPE (n = 50) and normotensive pregnancies (n = 90) were recruited
prior to childbirth. Serum samples were obtained from each participant <
48 hours before delivery to assess the concentrations of placental growth
factor (PIGF) and soluble fms-like tyrosine kinase-1 (sFlt-1) using the
Roche Elecsys platform. Each participant was followed up on postpartum days
zero, one, two and three to monitor BP and confirm antihypertensive
treatment. The optimal cut-off thresholds of sFlt-1/PIGF ratio from receiver
operating characteristic curve predictive of the antihypertensive therapy
were subjected to diagnostic accuracy assessment. Results The majority 58% (29/50) of sPE had multiple severe features of preeclampsia
in the antenatal period with the commonest presentation being severe
hypertension in 88% (44/50) of this group, followed by features of impending
eclampsia which occurred in 42% (21/50). The median gestational age at
delivery was 38 (Interquartile range, IQR 1) vs 36 (IQR 6)
weeks, p < 0.001 in normotensive and sPE groups
respectively. Notably, the median sFlt-1/PIGF ratio in normotensive and sPE
groups were 7.3 (IQR 17.9) and 179.1 (IQR 271.2) respectively,
p < 0.001. Of the 50 sPE participants, 34% (17/50)
had early-onset preeclampsia. The median (IQR) of sFlt-1/PIGF in the early-
and late-onset preeclampsia groups were 313.52 (502.25), and 166.59(195.37)
respectively, p = 0.006. From postpartum days zero to
three, 48% (24/50) of sPE received ≥ 3 slow- and/or a rapid-acting
antihypertensive drug. However, the daily administration of ≥ 3 slow- and/or
a rapid-acting antihypertensive drug in sPE were pre-delivery 26% (13/50),
postpartum day zero 18% (9/50), postpartum day one 34% (17/50), postpartum
day two 24% (12/50) and postpartum day three 20% (10/50). In sPE, the
pre-delivery sFlt-1/PIGF ratio was predictive of administration of ≥3 slow-
and/or a rapid-acting antihypertensive drug on postpartum days zero, one and
two with the optimal cut-off ratio being ≥315.0, ≥181.5 and ≥ 267.8
respectively (sensitivity 72.7–75.0%, specificity 64.7–78.6%, positive
predictive value 40.0–50.0% and negative predictive value 84.6% - 94.3%).
The predictive performance of sFlt-1/PIG ratio on postpartum day 3 among the
sPE was not statistically significant (area under receiver operating
characteristic curve, 0.6; 95% CI, 0.3–0.8). Conclusion A pre-delivery sFlt-1/PIGF ratio (< 181.5) is a promising predictor for
excluding the need for ≥3 slow- and/or a rapid-acting antihypertensive drug
therapy in the immediate postpartum period in sPE.
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Affiliation(s)
- Nnabuike Chibuoke Ngene
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal,
South Africa
- * E-mail:
| | - Jagidesa Moodley
- Women’s Health and HIV Research Group, Department of Obstetrics and
Gynaecology, University of KwaZulu-Natal, South Africa
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Phoswa WN, Naicker T, Ramsuran V, Moodley J. Pre-eclampsia: the role of highly active antiretroviral therapy and immune markers. Inflamm Res 2018; 68:47-57. [PMID: 30276649 DOI: 10.1007/s00011-018-1190-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE OF THE REVIEW This review highlights the role immune cells and markers such as natural killer (NK) cells, cytokines and human leukocyte antigen (HLA-G) play in predisposing HIV-infected women who are on HAART to develop PE, thus contributing to a better understanding and early diagnosis of PE with a subsequent reduction in maternal foetal and neonatal deaths. RECENT FINDINGS Pregnant women infected with the Human Immunodeficiency Virus (HIV) have a 25% risk of mother to child transmission. This risk, however, decreases to 2% if the women is on treatment. Highly active antiretroviral therapy (HAART) is the recommended treatment for both pregnant and non-pregnant women infected with HIV. Treatment with HAART is reported to potentiate predisposition to the development of hypertensive disorders of pregnancy such as pre-eclampsia (PE). Pre-eclampsia accounts for 7-10% of abnormal pregnancies worldwide. Studies demonstrate that pregnant women with HIV have PE at lower frequencies than uninfected women, however, the converse is observed upon HAART initiation. HIV-infected women on HAART exhibit a greater tendency to develop PE, emanating from immune reconstitution induced by HAART. There is paucity of information as to the pathogenesis of PE upon HAART initiation and there are, therefore, controversial data as to whether HAART predisposes women to a lower, equal or higher risk of PE development compared to the general population, further investigations on the impact of HIV infection and HAART on the immune response and rate of PE development in HIV infected pregnant women are urgently needed.
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Affiliation(s)
- Wendy N Phoswa
- Discipline of Obstetrics and Gynaecology, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - Thajasvarie Naicker
- Optics and Imaging Centre, University of KwaZulu-Natal, Durban, South Africa
| | - Veron Ramsuran
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, University of KwaZulu-Natal, Durban, South Africa
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Odun-Ayo F, Moodley J, Naicker T. Urinary clusterin and glutathione-s-transferase levels in HIV positive normotensive and preeclamptic pregnancies. Hypertens Pregnancy 2018; 37:160-167. [PMID: 30024772 DOI: 10.1080/10641955.2018.1498881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine the level and effect of urinary clusterin (CLU) and glutathione-s-transferase (GST) proteins in normotensive and preeclamptic pregnant women with HIV infection. METHODS The urine concentration of CLU and GST in normotensive (n = 38) and preeclamptic pregnant (n = 38) women stratified by HIV status were estimated using the Bio-Plex® ProTM immunoassay. RESULTS Across the group, a significant down-regulation of CLU (p = 0.039) with a reduced trend in GST was shown in HIV positive preeclampsia. CONCLUSION HIV infection affects the activity of urinary CLU protein in HIV positive preeclampsia. However, the cytoprotective role of these proteins neutralizes the oxidative radicals associated with preeclampsia development through complement response in HIV infection.
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Affiliation(s)
- Frederick Odun-Ayo
- a Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
| | - Jagidesa Moodley
- b Women's Health and HIV Research Unit, Nelson R Mandela School of Medicine , University of KwaZulu-Natal , Durban , South Africa
| | - Thajasvarie Naicker
- a Optics and Imaging Centre, Doris Duke Medical Research Institute, College of Health Sciences , University of KwaZulu-Natal , Durban , South Africa
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Aung M, Konoshita T, Moodley J, Gathiram P. Association of gene polymorphisms of four components of renin-angiotensin-aldosterone system and preeclampsia in South African black women. Eur J Obstet Gynecol Reprod Biol 2017. [DOI: 10.1016/j.ejogrb.2017.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Shange GP, Moodley J, Naicker T. Effect of vascular endothelial growth factors A, C, and D in HIV-associated pre-eclampsia. Hypertens Pregnancy 2017; 36:196-203. [PMID: 28524736 DOI: 10.1080/10641955.2017.1297821] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To measure and correlate the level of vascular endothelial growth factors A, C, and D in HIV-associated pre-eclampsia. METHODS VEGF-A, VEGF-C, and VEGF-D were measured in serum of 76 normotensive and pre-eclamptic pregnant women stratified by HIV status using Bio-Plex. RESULTS No significant difference was shown between pre-eclamptic and normotensive and between HIV negative and positive women. A strong significant positive correlation was demonstrated between VEGF-A and VEGF-C, VEGF-A and VEGF-D, and VEGF-C and VEGF D (p < 0.0001). CONCLUSION This study demonstrates a significant correlation between VEGF-A, VEGF-C, and VEGF-D and no difference in pre-eclamptic and normotensive pregnant women stratified by HIV status suggesting some neutralization of the immune response in HIV-associated pre-eclampsia.
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Affiliation(s)
- Gugulethu Promise Shange
- a Optics and Imaging Centre, Women's Health and HIV Research Unit, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban , South Africa
| | - Jagidesa Moodley
- a Optics and Imaging Centre, Women's Health and HIV Research Unit, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban , South Africa
| | - Thajasvarie Naicker
- a Optics and Imaging Centre, Women's Health and HIV Research Unit, Nelson R. Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban , South Africa
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Sebitloane HM, Moodley J, Sartorius B. Associations between HIV, highly active anti-retroviral therapy, and hypertensive disorders of pregnancy among maternal deaths in South Africa 2011-2013. Int J Gynaecol Obstet 2016; 136:195-199. [PMID: 28099739 DOI: 10.1002/ijgo.12038] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/07/2016] [Accepted: 11/03/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To explore potential relationships between HIV and highly active anti-retroviral therapy (HAART), and hypertensive disorders of pregnancy (HDP). METHODS A retrospective secondary analysis of maternal-deaths data from the 2011-2013 Saving Mothers Report from South Africa. The incidence of HIV infection amongst individuals who died owing to HDP was determined and comparisons were made based on HIV status and the use of HAART. RESULTS Among 4452 maternal deaths recorded in the Saving Mothers report, a lower risk of a maternal deaths being due to HDP was observed among women who had HIV infections compared with women who did not have HIV (relative risk [RR] 0.57, 95% confidence interval [CI] 0.51-0.64). Further, reduced odds of death being due to HDP were recorded among women with AIDS not undergoing HAART compared with women with HIV who did not require treatment (RR 0.42, 95% CI 0.3-0.58). Notably, among all women with AIDS, a greater risk of death due to HDP was demonstrated among those who received HAART compared with those who did not (RR 1.15, 95% CI 1.02-1.29). CONCLUSION HIV and AIDS were associated with a decreased risk of HDP being the primary cause of death; the use of HAART increased this risk.
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Affiliation(s)
- Hannah M Sebitloane
- Discipline of Obstetrics and Gynaecology, Nelson Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Unit, Discipline of Obstetrics and Gynaecology, Nelson Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Benn Sartorius
- Discipline of Public Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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