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