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Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study)

Dadabhai, Sufia, PhD*; Gadama, Luis, FCOG; Chamanga, Rachel, MBBS; Kawalazira, Rachel, MBBS; Katumbi, Chaplain, BSc; Makanani, Bonus, FCOG; Dula, Dingase, MBBS; Hua, Nan, MSc*; Lau, Bryan, PhD*; Mallewa, Macpherson, PhD§; Taha, Taha E., PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: January 1, 2019 - Volume 80 - Issue 1 - p 7–14
doi: 10.1097/QAI.0000000000001875
Epidemiology
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Background: Adverse pregnancy outcomes such as preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) remain major global problems. We compared pregnancy outcomes among HIV-infected women receiving antiretroviral treatment (ART) and with CD4 ≥350 cells, and HIV-uninfected women to assess whether disparities associated with HIV infection have been eliminated through use of ART.

Setting: Observational study conducted at 5 health facilities in Blantyre, Malawi, during 2016–2017.

Methods: HIV-infected women receiving the national ART regimen (efavirenz + lamivudine + tenofovir) and HIV-uninfected women were consented and enrolled at delivery. Data collected included sociodemographic and clinical; gestational age; BW; infant/maternal anthropometry; and laboratory results. We defined PTB as GA <37 weeks; LBW as BW <2·5 kg; and SGA as BW <10th percentile of GA. SGA infants were classified into proportionate and disproportionate based on ponderal index. Descriptive, stratified, and multivariate logistic and linear regression analyses were used.

Results: Of 5423 women approached, 614 HIV-infected and 685 HIV-uninfected women were enrolled. Rates of PTB, LBW, and SGA were 10.6%, 7.2%, and 17.1% among HIV-infected women on ART and 9.5%, 5.0%, and 18.4% among HIV-uninfected women, respectively. None of these differences were statistically significant in univariate- or multivariate-adjusted analyses (P > 0.05). Of 231 SGA infants, 78.8% were proportionate and 21% were disproportionate. Of the 614 HIV-infected women on ART, 75% had undetectable virus at delivery.

Conclusions: ART use has reduced the high rates of adverse pregnancy outcomes among HIV-infected women. However, the rates remain high irrespective of HIV infection and require appropriate interventions.

*Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;

Department of Obstetrics and Gynecology, College of Medicine, University of Malawi, Blantyre, Malawi;

Johns Hopkins-College of Medicine Research Project, Blantyre, Malawi; and

§Department of Pediatrics, College of Medicine, University of Malawi, Blantyre, Malawi.

Correspondence to: Taha E. Taha, PhD, Rm E7132, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205 (e-mail: ttaha1@jhu.edu).

Supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health; grant R21HD085874. B.L. was supported by the Johns Hopkins University Center for AIDS Research funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health; grant # P30-AI094189.

Presented in part at the IAS Conference on HIV Science; July 23–26, 2017; Paris, France, and the Conference on Retroviruses and Opportunistic Infections; March 4–7, 2018; Boston, MA.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received April 23, 2018

Accepted September 03, 2018

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