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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e3182a2d13c
Epidemiology and Prevention

Severity of Maternal HIV-1 Disease Is Associated With Adverse Birth Outcomes in Malawian Women: A Cohort Study

Turner, Abigail Norris PhD*,†; Tabbah, Sammy MD; Mwapasa, Victor MBBS, PhD§; Rogerson, Stephen J. FRACP, PhD; Meshnick, Steven R. MD, PhD; Ackerman, William E. IV MD; Kwiek, Jesse J. PhD*,#

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Abstract

Background: Compared with HIV-negative women, HIV-infected women have increased risk of low birthweight (LBW) and preterm delivery (PTD). We assessed whether severity of maternal HIV-1 disease was associated with LBW or PTD.

Methods: Secondary analysis of The Malaria and HIV in Pregnancy prospective cohort, which enrolled HIV-positive, pregnant Malawian women from 2000 to 2004. Included participants (n = 809) were normotensive antiretroviral treatment–naive women who delivered a live singleton infant. Binomial regression models were used to assess the unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) of the effect of severity of HIV-1 disease, defined by viral load and CD4+ T-cell counts, on prevalence of LBW and PTD.

Results: In unadjusted analyses, among those with malaria (n = 198), there was no association between severity of HIV-1 infection and LBW, whereas among women without malaria (n = 611), we observed a harmful association between both increasing peripheral viral load and LBW (PR: 1.44 per 1-log10 increase, 95% CI: 1.12 to 1.86) and placental viral load and LBW (PR: 1.24 per 1-log10 increase, 95% CI: 1.00 to 1.53). We observed a similar association between increasing placental viral load and PTD (PR: 1.33 per one-log10 increase, 95% CI: 1.04 to 1.69). These associations persisted in multivariate models adjusted for residence, maternal education, primigravid status, and maternal anemia.

Conclusions: In malaria-negative women, maternal HIV-1 disease severity was significantly associated with increased prevalence of LBW and PTD. Such an association was not found in the malaria-infected women.

© 2013 by Lippincott Williams & Wilkins

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