HIV Associated Preeclampsia: A Multifactorial Appraisal

Area of Science:

• Reproductive immunology
• Infectious diseases
• Cardiovascular research

Background:

• Preeclampsia (PE) and HIV-1 infection involve complex interactions affecting maternal and fetal health.
• Both conditions are associated with vascular dysfunction, oxidative stress, and altered immune responses.
• Antiretroviral therapy (ART) used for HIV-1 management can also influence these pathways.

Purpose of the Study:

• To review and synthesize the dysregulated pathways in preeclampsia, HIV infection, and ART usage.
• To explore the roles of angiogenesis, vascular dysfunction, complement system, RAAS, apoptosis, and NETosis.
• To understand the impact of combined HIV-1 and PE on endothelial cell function and immune reconstitution.

Main Methods:

• Literature review of studies on preeclampsia, HIV-1 infection, and ART.
• Analysis of cellular pathways including angiogenesis, apoptosis, NETosis, and immune responses.
• Examination of the effects of HIV-1 proteins and ART on endothelial cells.

Main Results:

• HIV-1 proteins elevate oxidative stress, apoptosis, and adhesion markers, while enhancing infectivity through C5a release.
• Preeclampsia presents an oxidative stress environment with increased apoptosis and NETosis, but decreased angiogenesis.
• ART, including protease inhibitors and nucleoside reverse transcriptase inhibitors, affects similar pathways, leading to endothelial cell dysfunction.

Conclusions:

• HIV-1 infection, preeclampsia, and ART differentially impact endothelial cell function.
• Endothelial dysfunction is predominant when HIV-1 infection and preeclampsia coexist.
• Understanding these interactions is crucial for managing immune reconstitution in co-infected pregnant individuals.