Intrahepatic Cholestasis of Pregnancy and Serum Bile Acids in HIV-Infected Pregnant Women

Abstract

Objectives: Intra-hepatic cholestasis of pregnancy (ICP) is uncommon, but has severe effects on pregnancy outcomes. ICP is characterized by elevated serum bile acids and liver enzymes and preferentially affects women with liver disorders. We compared bile acids and pregnancy outcomes of HIV-infected pregnant women, who commonly have elevated live enzymes, with uninfected controls.

Methods: Twenty-four HIV-infected, including 2 co-infected with hepatitis C virus (HCV), and 25 uninfected women were tested during early and late pregnancy and postpartum.

Results: After exclusion of the HCV-infected women, serum bile acids were similar in HIV-infected and uninfected participants. -glutamyl transpeptidase was elevated in HIV-infected compared with uninfected women during pregnancy and postpartum. Bilirubin and aspartate transaminase were higher in uninfected compared with HIV-infected women in early pregnancy, but subsequently similar. Bile acids in late pregnancy correlated with bile acids in the baby at birth. An HIV- and HCV-co-infected pregnant woman with active hepatitis developed ICP complicated by fetal distress. Another co-infected participant without active hepatitis had an uneventful pregnancy and delivery.

Conclusion: In the absence of HCV co-infection, bile acid metabolism appeared to be similar in HIV-infected and uninfected pregnant women. Both HIV-infected and uninfected pregnant women had mild liver enzyme elevations.

Keywords: Antiretroviral Therapy; Bile acids; Hepatitis C virus; Human Immunodeficiency Virus; Intrahepatic cholestasis; Liver function; Pregnancy.

Figure 1

Correlation analyses of maternal serum bile acid and liver enzyme levels during late pregnancy. Data were derived from 43 pregnant women. Panels A, B and C show correlation analyses of bile acid levels with AST, ALT and GGT levels, respectively. Spearman coefficients of correlation and p values are shown on each graph.

Figure 2

Association of late pregnancy maternal and infant cord blood bile acid levels. Data were derived from 25 mother-infant pairs. The levels tended to correlate (rho=0.38, p=0.059).