Birth Weight and Preterm Delivery Outcomes of Perinatally vs Nonperinatally Human Immunodeficiency Virus-Infected Pregnant Women in the United States: Results From the PHACS SMARTT Study and IMPAACT P1025 Protocol

Jao, Jennifer; Kacanek, Deborah; Williams, Paige L.; Geffner, Mitchell E.; Livingston, Elizabeth; Sperling, Rhoda; Patel, Kunjal; Bardeguez, Arlene; Burchett, Sandra; Chakhtoura, Nahida; Scott, Gwendolyn B.; Dyke, Russell B. Van; Abrams, Elaine J.; Yogev, Ram; Sanders, Margaret Ann; Hunter, Scott J.; Shearer, William T.; Paul, Mary E.; Cooper, Norma; Harris, Lynnette; Purswani, Murli; Stuard, Emma; Cintron, Anna; Puga, Ana María Méndez; Cooley, Dia; Garvie, Patricia A.; Blood, James; Borkowsky, William; Vasserman, Marsha; Dieudonne, Arry; Allison, Kim; Wilkins, Megan L.; Acevedo-Flores, Midnela; Angeli-Nieves, Lourdes; Olivera, Vivian; Kohlhoff, Stephan; Dennie, Ava; Bewley, Susan; Dyke, Russell Van; Craig, Karen L.; Sirois, Patricia A.; Crain, Marilyn J.; Hickman, Paige; Marullo, Dan; Norris, Kim; Nichols, Sharon L.; McFarland, Elizabeth J.; Chambers, Carrie Anne; Stowers, Kristi; Mahmoudi, Saniyyah; Usitalo, Ann; Hayani, Karen C.; Rich, Kenneth; Richardson, Lourdes; Smith, Renee; Mitchell, Charles D.; Dominguez, S.; Florez, Claudia; Frederick, Toni; Davtyan, Mariam; Morales-Avendano, Guadalupe; Rodriguez, Zoe; Heyer, Ibet; Trifilio, Nydia Scalley; Watts, Heather; Huo, Yanling; Hernández, Alicia; Tuomala, Ruth; Smith, Elizabeth G.; Oden, KaSaundra M; Leister, Erin; Shapiro, David E.; Barr, Emily; Wara, Diane W.; Guiterrez, Jenny; Malee, Kathleen; Lurie, Ann; Robert, H.; Bryson, Yvonne J.; Basar, Michael; Adriane, Hernandez; Jennings, Amy; Cressey, Tim R.; Bryant, Jennifer; Bettica, Linda; Calilap-Bernardo, Charmane; Higgins, A.; Silva, Gina; Gaddipati, Sreedhar; Spector, Stephen A.; Hull, Andrew; Caffery, Mary; Manning, Jean; Donnelly, Margaret; Wilson, Joan; Giner, Julia; Karthas, Nancy; Tucker, Lisa; Buck, Arlene; Kneut, Catherine; Deygoo, Sandra; Kaul, Aditya; Minter, Maryam; Akleh, Siham; Robson, A. A.; Hitti, Jane; Venema-Weiss, Corry; Klastorin, Anna; Bruder, Karen; Lewis, Gail D.; Casey, Denise; Parker, Sara Lynn; Scott, Rachel K.; Tanjutco, Patricia; Emmanuel, Vanessa; Mimoso, Antonio; Dı́az, Rodrigo; Perez, E.; Pereira, O T; Griffin, Jennifer; Ogburn, Paul L.; Stek, Alice; Kramer, Françoise; Spencer, LaShonda; Kovács, Andrea; Rathore, Mobeen H.; Delke, Isaac; Thomas, Geri; Millwood, Barbara; Katai, Alisa; Kennedy, Tara; Kinzie, Kay; Wallace, Jenna; Schmidt, Julie Berg; Cejtin, Helen E.; McNichols, Maureen F.; Senka, Judith; Cohan, Deborah; Anderson, Jean; Sheridan-Malone, Eileen; Tolentino-Balbridge, Chritina; Jackson-Alvarez, Janielle; Michalik, David E.; Batra, Jagmohan; Watson, Douglas C.; Johnson, Marı́a Cecilia; Hilyard, Corinda; Maupin, Robert; Dola, Chi; Luster, Yvette; Bradford, Sheila; Tita, Alan; Parks, Micky; Robbins, Sharan; Thorpe, Edwin M.; Knapp, Katherine M.; Finnie, Pamela; Sublette, Nina; Zorrilla, Carmen; Tamayo-Agrait, Vivian; Wright, R J; Cormier, Sharon; Luzuriaga, Katherine

doi:10.1093/cid/cix488

Cited by 16 publications

(7 citation statements)

References 29 publications

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“…In our study population, women with PHIV were more often immunosuppressed during pregnancy and virally unsuppressed near delivery than those with NPHIV. These observations are consistent with several other studies [22,[36][37][38][39][40]. One study found that a delivery HIV RNA level less than 400 copies/ml was associated with increased WTZ and WLZ from birth to 1 year when adjusting for maternal mode of HIV Based on models adjusted for maternal age at delivery, figures show the estimated slopes of CHEU-PHIV and CHEU-NPHIV before and after the change-point, as well as mean slope differences and differences (arrows) at certain ages with 95% confidence intervals (95% CI).…”

Section: Discussionsupporting

confidence: 94%

Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV

Jacobson

Williams

et al. 2021

Aids

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Objective: The aim of this study was to compare long-term growth between HIV-exposed uninfected children (CHEU) born to women with perinatally acquired HIV (CHEU-PHIV) and CHEU born to women with nonperinatally acquired HIV (CHEU-NPHIV).Design: A longitudinal analysis of anthropometric measurements from a U.S.-based multisite prospective cohort study enrolling CHEU and their mothers since April 2007.Methods: CHEU were evaluated for growth annually from birth through age 5 and again at age 7 years. Z-scores were calculated using U.S. growth references for weight (WTZ), height (HTZ), and weight-for-length or BMI-for-age (WLZ/BMIZ). Mid-upper arm circumference (MUACZ) and triceps skinfold thickness (TSFZ) Z-scores were obtained from ages 1 and 2, respectively, through age 7 years. Piecewise mixed-effects models, overall and stratified by race and sex, were fit to assess differential growth patterns across age by maternal PHIV status.Results: One thousand four hundred fifty-four singleton infants (286 CHEU-PHIV and 1168 CHEU-NPHIV) were included. CHEU-PHIV had slower growth rates than CHEU-NPHIV for WTZ and WLZ/BMIZ at earlier ages and continued to have lower mean WTZ [À0.27, 95% confidence interval (95% CI): À0.50, À0.04] and WLZ/BMIZ (À0.39, 95% CI: À0.67, À0.11) through age 7. Among non-Black boys, CHEU-PHIV had slightly lower WTZ and WLZ/BMIZ at birth than CHEU-NPHIV and these growth deficits persisted through age 7 years. Conclusion:Compared with CHEU-NPHIV, CHEU-PHIV had diminished growth in early childhood with differences most pronounced among non-Black male children. Further longitudinal follow-up of CHEU-PHIV into young adulthood is needed to understand whether these early effects of maternal PHIV status on growth persist and have other health consequences.

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Section: Discussionsupporting

confidence: 94%

Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV

Jacobson

Williams

et al. 2021

Aids

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“…These women had lower mean CD4 counts and were less likely to be virally suppressed, both early and late in pregnancy, than women with non-perinatally acquired HIV. Previous reports from the SMARTT study 26,27 and others have similarly reported that women with perinatallyacquired HIV have lower baseline CD4 counts at conception and are at greater risk for detectable VL near delivery. 28,29 These differences in baseline CD4 count may be attributable to suboptimal ART regimens, drug resistance, and/or suboptimal adherence due to psychosocial factors.…”

Section: Discussionmentioning

confidence: 80%

Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth

O’Brien

Williams

Huo

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND-Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. Additionally, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized.METHODS-We studied WLHIV with ≥2 liveborn infants enrolled into the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring for ART Toxicities (SMARTT) study between 2007-2018, comparing CD4 counts and viral loads (VLs) between two consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression, and the association of PI/INSTI use during pregnancy with odds of preterm birth.RESULTS-There were 736 women who had ≥2 liveborn children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. While > 80% of women achieved VL suppression during pregnancy, more than half had detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with 1 st trimester PI initiation (adjusted odds ratio [OR] 1.97; 95% CI 1.27, 3.07) compared to those not receiving PIs during pregnancy, and for 1 st trimester INSTI initiation (adjusted OR 2.39; 95% CI 1.04, 5.46) compared to those never using INSTIs during pregnancy. CONCLUSIONS-MostWLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with higher risk of preterm birth.

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“…18 Given the current opioid crisis in the United States, maternal HIV infection associated with parenteral drug use may be on the rise. 19 Preterm birth rates were similar among women delivering in rural and urban areas. Adequate prenatal care and timely initiation of indicated progesterone therapy may mitigate the increased risk of perinatal HIV transmission conferred by preterm birth.…”

Section: Discussionmentioning

confidence: 93%

“…Women who inject drugs are also candidates for preexposure prophylaxis for the prevention of HIV . Given the current opioid crisis in the United States, maternal HIV infection associated with parenteral drug use may be on the rise . Preterm birth rates were similar among women delivering in rural and urban areas.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Delivery in a Rural County on a Cohort of Women Living with HIV Infection and Their Infants

Lazenby

Powell

Sullivan

et al. 2018

The Journal of Rural Health

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Birth Weight and Preterm Delivery Outcomes of Perinatally vs Nonperinatally Human Immunodeficiency Virus-Infected Pregnant Women in the United States: Results From the PHACS SMARTT Study and IMPAACT P1025 Protocol

Abstract: IMPAACT 1025, NCT00028145.

Cited by 16 publications

References 29 publications

Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV

Growth patterns of uninfected children born to women living with perinatally versus nonperinatally acquired HIV

Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth

The Impact of Delivery in a Rural County on a Cohort of Women Living with HIV Infection and Their Infants

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