Objective: To explore potential relationships between HIV and highly active anti-retroviral therapy ( HAART), and hypertensive disorders of pregnancy ( HDP). Methods: A retrospective secondary analysis of maternal-deaths data from the 20112013 Saving Mothers Report from South Africa. The incidence of HIV infection amongst individuals who died owing to HDP was determined and comparisons were made based on HIV status and the use of HAART. Results: Among 4452 maternal deaths recorded in the Saving Mothers report, a lower risk of a maternal deaths being due to HDP was observed among women who had HIV infections compared with women who did not have HIV ( relative risk [RR] 0.57, 95% confidence interval [CI] 0.51-0.64). Further, reduced odds of death being due to HDP were recorded among women with AIDS not undergoing HAART compared with women with HIV who did not require treatment (RR 0.42, 95% CI 0.3-0.58). Notably, among all women with AIDS, a greater risk of death due to HDP was demonstrated among those who received HAART compared with those who did not (RR 1.15, 95% CI 1.02-1.29). Conclusion: HIV and AIDS were associated with a decreased risk of HDP being the primary cause of death; the use of HAART increased this risk.