CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 52 AFRICA Review Article Pre-eclampsia: does cardiac function differ in HIV-positive and -negative women? Raeesa Bhorat, Ismail Bhorat, Olive P Khaliq, Jagidesa Moodley Abstract This review aimed to establish the impact of pre-eclampsia and HIV infection on cardiac function. Cardiovascular diseases have been reported to affect pregnancies complicated by both HIV and pre-eclampsia. Pre-eclampsia has been found to be associated with both systolic and diastolic dysfunction. Currently it has been found that there may be a dual, bidirectional pathophysiology, where placenta-mediated factors can influence cardiac function, or pre-existing cardiovascular disease can predispose to pre-eclampsia. Cardiovascular disease, HIV and pre-eclampsia are major health challenges individually and are interrelated with regard to pathophysiology. It has been found that both pre-eclampsia and HIV contribute to cardiac dysfunction as does the impact of antiretroviral therapy. Further research is needed to investigate the link between these diseases for the development of novel therapeutic interventions. Keywords: pre-eclampsia, HIV, ART, cardiovascular disease Submitted 14/4/22; accepted 7/2/23 Published online 11/5/23 Cardiovasc J Afr 2024; 35: 52–63 www.cvja.co.za DOI: 10.5830/CVJA-2023-005 Maternal health is often a representation of the adequacy and efficacy of a healthcare system. The success of modern medicine has been measured by its positive impact on maternal mortality in recent times. However, even though progress is evident, statistics reverberate that shortcomings persist despite global initiatives to improve maternal healthcare. Human immunodeficiency virus (HIV), cardiovascular disease and hypertensive disorders in pregnancy (HDP) are some of the leading causes of maternal mortality, particularly in poorly resourced settings. There has been a decline in maternal deaths from HIV infection over the period 2008–2016, however, there has been no significant change in mortality rate related to HDP.1,2 Both HIV and cardiovascular diseases contribute largely to the disease burden in South Africa and are interwoven in terms of pathogenesis, leading to augmentation and perpetuation of disease. This review serves to illustrate the link between the disease entities, provide pathophysiological insights to better understand disease manifestations, and allow for early recognition, ultimately leading to the development of therapeutic interventions to alleviate suffering and contribute positively to decreasing maternal mortality in South Africa (SA). Epidemiology of HDP HDP are the commonest direct causes of maternal mortality and account for 18% of all maternal deaths in SA.3 HDP have a prevalence of approximately 5% in high-income countries, however, the prevalence is higher in low-income countries.1,4 The incidence of pre-eclampsia (PE), a pregnancy-specific category of HDP, was noted to be 12% in primigravidae in a large regional hospital in SA.3 The World Health Organisation (WHO) reported that PE accounts for 1.8–16.7% of maternal deaths in countries such as SA, Egypt, Tanzania and Ethiopia.1 Prevalence of HIV in SA HIV infection is a global health challenge. Sub-Saharan Africa accounts for 56% of the HIV-infected population and in 2017, women accounted for 59% of new adult infections.1,5 In SA, 13% of the population is HIV positive and 20% involve women of childbearing age (15–49 years).1 Epidemiology of cardiovascular disease in SA The global mortality and morbidity rate related to cardiac diseases in pregnancy has been reported to vary between 0.1 and 4%.6 In the UK, the confidential enquiries into maternal deaths found that the overall rate of mortality from cardiac diseases had increased from 7.3 per million (1982–1984) to 22.7 per million births (2003–2005).6 Department of Cardiology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa Raeesa Bhorat, MB ChB, FCP SA, MMED, raeesabhorat.1@gmail.com Foetal Medicine, Department of Obstetrics and Gynecology, University of KwaZulu-Natal, Durban, South Africa Ismail Bhorat, MB ChB, FCOG Department of Paediatrics and Child Health, University of the Free State, Bloemfontein, South Africa Olive P Khaliq, PhD Department of Obstetrics and Gynaecology and Women’s Health and HIV Research Group, University of KwaZuluNatal, Durban, South Africa Jagidesa Moodley, MB ChB, MD
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