Abstract
Human immunodeficiency virus (HIV) infection in pregnancy is associated with substantial
morbidity and mortality. Improved access to effective antiretroviral therapy (ART)
has shifted the spectrum of pregnancy-related complications among HIV-infected pregnant
women. In addition to placental vascular complications and preterm delivery, increased
rates of venous thromboembolism (VTE) have been described. HIV infection is characterized
by immune activation, inflammation, and endothelial dysfunction, which contribute
to the activation of coagulation and its prothrombotic consequences. Indeed, activated
coagulation factors have been reported to be increased and natural anticoagulants
reduced in HIV. Several mechanisms for this persistent prothrombotic balance on ART
have been identified. These may include: co-infections, immune recovery, and loss
of the gastrointestinal mucosal integrity with microbial translocation. In addition
to the direct effects of HIV and ART, traditional venous and obstetric risk factors
also contribute to the risk of VTE. A research priority has been to understand the
mechanisms of VTE in HIV-infected pregnant women receiving suppressive ART and to
translate this into HIV-specific thromboprophylaxis recommendations. Management requires
a multidisciplinary approach and further studies are indicated to guide the prevention
and management of pregnancy-associated VTE in this population. The current review
describes the epidemiology, mechanisms, and management of VTE in HIV-infected women
in pregnancy and the postpartum period.
Keywords
human immunodeficiency virus - pregnancy - venous thromboembolism
