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To evaluate the risk of preeclampsia in pregnant women with human immunodeficiency virus (HIV).This is a 26-year population-based retrospective cohort study. Human immunodeficiency virus–infected pregnant women were compared with a HIV-negative comparison group. The primary outcome was the incidence of preeclampsia. We planned subgroup analysis according to antiretroviral therapy.A total of 84,725 women were included in the analysis, of whom 453 were HIV-infected and 84,272 HIV-negative. Of the 453 HIV-infected women, 301 (66.4%) received highly active antiretroviral therapy (HAART group) during pregnancy, whereas 152 (33.6%) did not. After adjusting for confounders, we found that HIV-infected women had a significantly higher risk of preeclampsia (10.2% compared with 4.1%; adjusted odds ratio [OR] 2.68, 95% confidence interval [CI] 1.96–3.64), preeclampsia with severe features (4.0% compared with 2.0%; adjusted OR 2.03, 95% CI 1.26–3.28), early-onset (3.5% compared with 1.4%; adjusted OR 2.50, 95% CI 1.51–4.15) and late-onset preeclampsia (6.6% compared with 2.6%; adjusted OR 2.64, 95% CI 1.82–3.85), and preterm birth at less than 37 weeks of gestation (11.0% compared with 4.7%; adjusted OR 2.50, 95% CI 1.86–3.37) compared with the comparison group. Human immunodeficiency virus–infected women who received HAART had a significantly higher risk of preeclampsia compared with women without HIV (13.0% compared with 4.1%; adjusted OR 3.52, 95% CI 2.51–4.94) and compared with the non-HAART group (13.0% compared with 4.6%; adjusted OR 3.08, 95% CI 1.34–5.07). The non-HAART group had a similar risk compared with women without HIV (4.6% compared with 4.1%; adjusted OR 1.14, 95% CI 0.53–2.44).Human immunodeficiency virus–infected women had an increased risk of preeclampsia. Some of this risk seems to be linked to HAART.