A current HCV infection may increase the risk of preterm birth among HIV-positive women
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* Justyna D Kowalska
* Karolina Nowicka
* Agnieszka Wroblewska
* Ewa Firląg-Burkacka
* Magdalena Marczyńska

*   HIV
*   hepatitis C
*   sexual health
*   premature birth
*   pregnancy

In a recent publication, Baer *et al* pointed out that there are few studies on the association between sexually transmitted infections (STIs) and prematurity.1 Similarly, there are limited data on prematurity in the setting of HIV and HCV) co-infection. Many factors can contribute to preterm delivery in this population, both related and not related to HIV. For example, gestational age may be affected by HIV-related immunosuppression or use of antiretroviral therapy (ART).2 3 There is also evidence that in vitro HCV may infect the human trophoblast and cause ultrastructure changes.4 Relation between HCV infection and preterm birth has already been studied in HCV monoinfected population; however, HCV and HIV infections are rarely studied.5 We analysed the pregnancy outcomes in a cohort of HIV-positive women receiving integrated outpatient care at the Hospital for Infectious Diseases in Warsaw,6 whereby pregnant women are followed by a clinic gynaecologist within the HIV outpatient service. Care is delivered according to national standards which routinely include syphilis venereal disease research laboratory (VDRL) test at entering antenatal care and other STIs are screen based on risk behaviours or symptoms. All children born from HIV-positive mothers are followed at the Department of Children's Infectious Diseases.

Between 1 January 2006 and 31 December 2017, there were 187 registered pregnancies, of which 159 had known ART status and birth outcomes. Most women (125/159, 79.1%) showed a suppressed most recent plasma HIV-1 RNA before delivery and the median CD4 cell count was 525 (IQR: 371–652) cells/μL. STIs were rare, with 7/159 (4.4%) women showing positive VDRL and none being actively infected with chlamydia. Of the 159 women, 58 (39.5%) were anti-HCV positive and 43/159 (27%) had a current HCV infection (HCV RNA positive).

There were 19/159 (11.9%; 95% CI: 6.9 to 16.9) preterm births; gestational age was 32–36 weeks in 17/159 (10.7%) births and 28–31 in 2/159 (1.2%). The rate of preterm birth was higher than that observed in the general Polish population (7.6% of births in 2005).7 When comparing the preterm and term delivery groups, we did not identify significant differences in terms of conventional risk factors for pregnancy outcomes. By multivariate logistic regression analysis, a current HCV infection was the only variable associated with increased odds of preterm delivery (table 1). These data confirm previous observations of an increased risk of prematurity in HIV-positive women, and suggest that an active HCV infection may further increase the risk in the co-infected population.8 

View this table:
[Table 1](http://sti.bmj.com/content/96/5/335/T1)

Table 1 
Unadjusted and adjusted odds of preterm birth

Larger studies are needed to confirm these initial observations. Meanwhile, eliminating HCV among women in childbearing age remains a topic largely neglected by clinical guidelines. We believe that HCV infection status should be included in future studies of prematurity risks among women with HIV.

## Footnotes

*   Handling editor Anna Maria Geretti

*   Contributors All authors contributed to this work in equal parts. All authors declare no conflict of interest in relation to submitted work.

*   Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

*   Competing interests None declared.

*   Patient consent for publication Not required.

*   Provenance and peer review Not commissioned; internally peer reviewed.

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