Dr. Katelyn Rittenhouse, a first-year Global Women’s Health Fellow and former UNC School of Medicine OBGYN resident, presented on the association between preeclampsia and HIV infection among Zambian women at the 2024 Conference on Retroviruses and Opportunistic Infections in Denver, CO last weekend.
Dr. Rittenhouse presented as a New Investigator Scholar in the Themed Discussion Panel, “Hypertension and HIV: Pregnancy, Postpartum, and Beyond”, moderated by Elizabeth Stringer, professor of Maternal Fetal Medicine at UNC School of Medicine. “We investigated this association in a large, well-characterized Zambian pregnancy cohort and found that the crude and adjusted preeclampsia risk among women living with HIV was significantly reduced when compared to their uninfected counterparts,” said Dr. Rittenhouse. “This decreased risk persisted when we stratified women living with HIV by maternal disease status: by preconception antiretroviral therapy exposure, by detectable viral load at study enrollment, and by CD4 count at study enrollment.”
Understanding the association between preeclampsia and HIV may help to elucidate immune mechanisms underlying the development of hypertensive disorders of pregnancy, and identify targeted interventions to decrease preeclampsia risk. “Further understanding this relationship may allow obstetricians to better tailor antenatal care and monitoring for pregnant people living with HIV,” said Dr. Rittenhouse.
Hypertensive disorders of pregnancy, including preeclampsia, are the second leading cause of maternal mortality globally. Unfortunately, the pathophysiology underlying this disease process remains poorly understood, but one proposed mechanism of the disease is an abnormal maternal immune response to the fetal allograft. The immunosuppressive effects of HIV have been hypothesized to decrease the risk of preeclampsia. However, to date, this relationship remains poorly understood. Dr. Rittenhouse concludes that her findings support the need for further investigation into the possible mechanisms underlying the protective effects of HIV infection against preeclampsia.
Sub-Saharan Africa shares the highest age-standardized incidence and death rates of hypertensive disorders of pregnancy, and the region also shares the greatest burden of the global HIV pandemic. According to the CDC, prevalence of HIV among women in Zambia aged 15 and up is 13.9%. UNC Global Women’s Health has a long-standing presence in Zambia through UNC-Global Projects Zambia (UNC-GPZ). “For this analysis, we combined three contemporaneous UNC-GPZ antenatal studies performed between 2015 and 2022, including approximately 4,000 women (40% living with HIV) who were enrolled in early pregnancy, and followed through delivery and postpartum,” said Dr. Rittenhouse.
Dr. Katelyn Rittenhouse is the Global Women’s Health fellow in the UNC School of Medicine’s Department of Obstetrics and Gynecology. In addition to her fellowship, Dr. Rittenhouse also completed her OBGYN residency training at UNC Health. She is passionate about improving health care for women worldwide.