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La preeclampsia, el tratamiento antirretroviral y la reconstitución inmunológica
R C Wimalasundera1, N Larbalestier, J H Smith
1Department of Obstetrics and Gynaecology, Guys and St Thomas' NHS Trust, London, UK. r.wimalasundera@ic.ac.uk
Lancet (London, England)
|October 22, 2002
Resumen
La terapia antirretroviral para mujeres embarazadas con VIH-1 puede aumentar el riesgo de preeclampsia. La inmunodeficiencia en el VIH-1 está relacionada con tasas más bajas de preeclampsia, que se normalizan con el tratamiento.
Área de la Ciencia:
- Obstetricia y Ginecología.
- Enfermedades infecciosas Enfermedades infecciosas.
- Inmunología Inmunología.
Sus antecedentes:
- La terapia antirretroviral (TAR) es estándar para las mujeres embarazadas con el virus de la inmunodeficiencia humana tipo 1 (VIH-1) en el Reino Unido.
- Existen datos limitados sobre la seguridad materna y fetal de la terapia antirretroviral durante el embarazo, particularmente con respecto a la preeclampsia.
- La preeclampsia es una complicación grave del embarazo con riesgos significativos para la madre y el feto.
Objetivo del estudio:
- Investigar la asociación entre la terapia antirretroviral y la incidencia de preeclampsia en mujeres embarazadas con VIH-1.
- Explorar el papel del sistema inmunológico y la infección por VIH-1 en la patogénesis de la preeclampsia.
- Para comparar las tasas de preeclampsia en mujeres VIH-1-positivas que reciben TARV, mujeres VIH-1-positivas que no reciben TARV y mujeres embarazadas no infectadas.
Principales métodos:
- Un estudio de cohorte que involucró a 214 mujeres embarazadas con infección por VIH-1 en el Reino Unido.
- Comparación de las tasas de preeclampsia entre las mujeres que no recibieron ART, triple ART y controles no infectados.
- Análisis estadístico, incluidas las proporciones de probabilidad y los intervalos de confianza, para evaluar las asociaciones.
Principales resultados:
- Las mujeres con VIH-1 que no recibieron ART tuvieron una tasa significativamente menor de preeclampsia (0/61) en comparación con las que recibieron triple ART (8/76; OR 15.3, p=0.0087).
- La tasa de preeclampsia en mujeres VIH-1-positivas en tratamiento antirretroviral (8/76) no difirió significativamente de los controles no infectados (12/214; p=0.2).
- Los hallazgos sugieren que la inmunodeficiencia relacionada con el VIH-1 está asociada con una tasa reducida de preeclampsia, que se restaura con ART.
Conclusiones:
- El sistema inmunológico parece desempeñar un papel crucial en la patogénesis de la preeclampsia.
- ART puede normalizar la tasa de preeclampsia en mujeres embarazadas VIH-1-positivas a los niveles esperados.
- La superposición de las presentaciones clínicas y los efectos tóxicos de la TAR pueden complicar el diagnóstico y el tratamiento de la preeclampsia en esta población.
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