INTRODUCTION:
The primary aim was to evaluate differences in antiretroviral therapy (ART) use in pregnant women living with HIV (WLWH) according to timing of maternal HIV infection, including perinatal (PHIV). The secondary aim was to evaluate the effects of guideline-based maternal ART, including mono-, dual, and combination antiretrovirals (mARV, dARV, cART), on preterm delivery (PTD).
METHODS:
Data were obtained from the state Department of Health (SCDHEC) for WLWH delivering from 2004-2014. Perinatal outcomes were compared according to timing of maternal HIV diagnosis and maternal use of mARV, dARV, cART, and no ART. Bivariate outcomes were compared using χ2 or Fischer's exact tests. Continuous variables were compared using Wilcoxon Rank Sum Tests or Kruskal-Wallis tests.
RESULTS:
663 WLWH delivered 885 infants. 26 (3%) of infants were born to PHIV WLWH, 683 (77%) to WLWH diagnosed before pregnancy, and 185 (21%) to WLWH diagnosed during pregnancy. PTD was less likely among PHIV-exposed infants (4% vs. 24% vs. 16%, P=0.006). PHIV mothers were more likely to use cART (88% vs. 65% vs. 54%, P=0.001). PTD rates were similar among infants exposed to any ART (mARV 21% vs. dARV 20% vs. cART 21%, P=0.93), while infants not exposed to ART had higher PTD rates (38% vs. 31%, P=0.02).
CONCLUSION:
PTD was not increased by maternal PHIV or ART exposure. HIV-exposed infants not exposed to ART had higher PTD rates. These findings support maternal cART use for improved infant outcomes and challenge previous reports of worsened perinatal outcomes among PHIV WLWH.
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