Spontaneous Heterotopic Pregnancy in a Patient With HIV Infection: A Case Report

Abstract

Introduction: Heterotopic pregnancy, defined as the coexistence of an intrauterine and an extrauterine gestation, is a rare and potentially life-threatening condition. Its incidence in spontaneous conceptions is estimated at 1 in 30,000, but it may increase up to 300-fold with the use of assisted reproductive technologies. In women with human immunodeficiency virus (HIV) infection, the higher prevalence of sexually transmitted infections and pelvic inflammatory disease may further increase the risk of this entity. Case report: A 33-year-old woman with controlled HIV infection on antiretroviral therapy presented to the emergency department with sudden-onset abdominal pain and scant vaginal bleeding. Ultrasound revealed a 9-week intrauterine pregnancy and a ruptured left tubal ectopic pregnancy with hemoperitoneum. Exploratory laparotomy with left salpingectomy was performed, preserving the intrauterine gestation. The pregnancy progressed without complications and concluded with an elective cesarean section at 38 weeks, yielding a healthy newborn. Discussion: Diagnosing heterotopic pregnancy in patients with HIV is challenging, as the identification of an intrauterine pregnancy may erroneously lead to ruling out a concurrent ectopic gestation. Transvaginal ultrasound with systematic adnexal evaluation is essential for early diagnosis. In cases of rupture and hemoperitoneum, immediate surgical intervention is the standard management, with the possibility of preserving the intrauterine pregnancy. Conclusion: This case—only the second reported in the literature involving an HIV-positive patient and the first to achieve a term intrauterine pregnancy following ectopic surgery—highlights the need to maintain a high index of suspicion even in spontaneous conceptions. It also underscores the importance of a multidisciplinary approach, timely diagnosis, and prompt surgical treatment to optimize maternal and fetal outcomes.