Association of Postpartum Cardiovascular Biomarkers with HIV Among Women with Recent Preeclampsia in Zambia.

Abstract

Objectives: Women recovering from preeclampsia with elevated vascular biomarkers have a higher risk of future cardiovascular diseases. We investigated whether HIV on treatment was associated with biomarkers of cardiovascular risk in the weeks following delivery.

Methods: We analyzed data from a six-month prospective cohort study conducted from January 2022 to June 2023. Following delivery and at six weeks postpartum, we measured cystatin C, high sensitivity C-reactive protein (hs-CRP), Interleukine-2 (IL-2), Interleukine-6 (IL-6) and Tumor necrosis factor-alpha (TNFa). A generalized linear regression model with Poisson distribution estimated the association between vascular biomarkers and HIV on treatment.

Results: This study included 75 participants with a median age of 29 years (interquartile range [IQR] = 27-34 years), with 35 (46.7%) living with HIV on ART and 40 (53.3%) HIV-negative. Women living with HIV on ART had higher levels of hs-CRP than HIV-negative women (4.68 mg/l vs 3.60 mg/l, p = 0.025) at six weeks. On the other hand, women living with or without HIV on ART had similar levels of cystatin C (0.78 mg/l vs 0.81 mg/l, p = 0.303), IL-2 (0.64 pg/ml vs 0.67 pg/ml, p = 0.131), IL-6 (0.64 pg/ml vs 0.64 pg/ml, p = 0.422), and TNFa (24.2 pg/ml vs 24.1 pg/ml, p = 0.346). Living with HIV while on ART was associated with an increased risk of presenting as hypertensive with elevated hs-CRP (aRR = 2.88, 95% CI: 1.09-7.60).

Conclusions: Women living with HIV on ART had elevated hs-CRP but similar levels of other biomarkers after preeclampsia. Further studies are needed to explore the differential impact of HIV disease vs. antiretroviral treatment on inflammatory responses.