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P3.198 Severity of Maternal HIV-1 Disease is Associated with Adverse Birth Outcomes in Malawian Women
  1. A Norris Turner1,
  2. S Tabbah2,
  3. V Mwapasa3,
  4. S J Rogerson4,
  5. S R Meshnick5,
  6. W Ackerman IV6,
  7. J J Kwiek7
  1. 1Division of Infectious Diseases, Ohio State University, Columbus, OH, United States
  2. 2Department of Obstetrics and Gynecology, Ohio State University, Columbus, OH, United States
  3. 3Department of Community Health, Malawi College of Medicine, Blantyre, Malawi
  4. 4Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
  5. 5Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
  6. 6Ohio State University, Department of Obstetrics and Gynecology, Columbus, OH, United States
  7. 7Department of Microbial Infection and Immunity, The Department of Microbiology, and The Center for Retrovirus Research, Ohio State University, Columbus, OH, United States

Abstract

Background HIV-infected women have increased risk of adverse birth outcomes, including low birth weight (LBW) and preterm delivery (PTD). We assessed whether severity of maternal HIV-1 disease - characterised by HIV-1 viral load in peripheral blood, HIV-1 viral load in placental blood, and maternal CD4+ T-cell count - was associated with LBW or PTD.

Methods We performed secondary analyses of The Malaria and HIV in Pregnancy prospective cohort, which enrolled HIV-positive, pregnant Malawian women from 2000–2004. Included participants (n = 809) were antiretroviral treatment-naïve, normotensive women who delivered a live, singleton infant. Binomial regression models were used to assess unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) of the effect of HIV-1 severity on prevalence of LBW and PTD.

Results The relationships between HIV-1 severity and LBW or PTD differed by malaria status. Among malaria-positive women (n = 198), after adjustment for residence, education, primigravidity, and maternal anaemia, we observed no association between severity of HIV-1 disease and LBW or PTD. However among malaria-negative women (n = 611), increasing peripheral viral load was significantly associated with LBW (adjusted PR: 1.41 per one-log10 increase, 95% CI: 1.10, 1.82); results were similar for increasing placental viral load and LBW (adjusted PR: 1.23 per one-log10 increase, 95% CI: 1.02, 1.49), and decreasing CD4+ T-cell count and LBW (adjusted PR per 100-cell/μL decrease: 1.12 per 95% CI: 1.04, 1.21). We observed a similar association between placental viral load and PTD (adjusted PR: 1.29 per one-log10 increase, 95% CI: 1.02, 1.64) and CD4+ T-cell count and PTD (adjusted PR per 100-cell/μL decrease: 1.16 per 95% CI: 1.05, 1.28).

Conclusion Although our malaria-positive sample size was small, HIV-1 severity in this group appeared not to be associated with adverse birth outcomes. However in malaria-negative women, maternal HIV-1 disease severity was significantly associated with increased prevalence of LBW and PTD.

  • birth outcomes
  • HIV
  • women

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