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

Abstract

Background Compared to HIV-negative women, HIV-infected women have increased risk of low birth weight (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 2000–2004. Included participants (n=809) were normotensive, antiretroviral treatment naïve 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-positive 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, while among women without malaria (n=611), we observed a harmful association between both increasing peripheral viral load and LBW (PR: 1.44 per one-log10 increase, 95% CI: 1.12, 1.86) and placental viral load and LBW (PR: 1.24 per one-log10 increase, 95% CI: 1.00, 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, 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.

Soluble CD14 levels in plasma and breastmilk of Malawian HIV+ women: Lack of association with morbidity and mortality in their exposed infants

“…In our study, we found an association between maternal plasma levels of sCD14 during the second half of pregnancy and low neonatal birthweight. This association persisted ( P = .043) in a multivariate regression model adjusted for demographic and clinical characteristics known to be potential risk factors for low birthweight . To our knowledge, this is the first time that this association is observed in low‐income countries, where the role of systemic immune activation markers may be confounded by other factors, such as malnutrition and maternal comorbidities, including opportunistic infections and/or vector transmissible diseases.…”

“…The association between maternal levels of sCD14 and birthweight was tested using a multivariable linear regression model, controlling for potential confounding factors. The selection of potential confounding variables, including both demographic and clinical characteristics, was based on previous data and the available information in this study. Differences were considered statistically significant when P < .05.…”

Chlamydia trachomatis and Neisseria gonorrhoeae in HIV-infected Pregnant Women and Adverse Infant Outcomes

“…(30-33) Yet, our stratified analysis findings demonstrating that women with STIs had higher rates of low birth weight and premature infants remained, even after controlling for infant HIV status. Those findings were also not explained by high rates of untreated maternal syphilis (10%), as they persisted in a second analysis controlling for this variable.…”

Reassuring Birth Outcomes With Tenofovir/Emtricitabine/Efavirenz Used for Prevention of Mother-to-Child Transmission of HIV in Botswana

“…Given the link between immunodeficiency and adverse outcomes in prior studies [26-28] CD4 cell count was included as a covariate in all analyses. The remainder of covariates in adjusted analyses were determined through stepwise selection with retention of variables with p<0.2.…”