Severity of Maternal HIV Disease and Adverse Birth Outcomes
Severity of Maternal HIV Disease and Adverse Birth Outcomes
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.
Women of child-bearing age comprise approximately half of the estimated 33.3 million people living with HIV-1. Children born to HIV-infected women have an increased risk of adverse birth outcomes, including congenital HIV-1 infection and low birthweight (LBW). Malaria is also prevalent among pregnant women, and children born to women with malaria also have an increased risk of LBW. LBW is defined as "infants born weighing <=2500 g, regardless of gestational age or cause of LBW," and it can be caused by preterm delivery (PTD, birth before 37 week's gestation), intrauterine growth restriction, or congenital/genetic abnormalities. LBW is a significant cause of infant morbidity and mortality. In 2010, PTD was the second leading cause of child deaths worldwide, and Malawi had the highest prevalence of PTD in the world.
The placenta provides fetal nourishment and serves as a barrier to fetal infection, and deficiencies in placental function are causally linked to obstetric complications. Infections that colonize the placenta, such as Plasmodium falciparum, are associated with adverse birth outcomes.Plasmodium falciparum parasites can be sequestered in the intervillous space of the placenta, and placental malaria has been associated with higher HIV-1 concentration in both peripheral and placental plasma. Our group and others have shown that HIV-1 replicates in the placenta, and it has also been shown that HIV-1 infection alters the cytokine profile in the placenta. Thus, when evaluating risk factors for adverse birth outcomes, potential interactions between malaria and HIV-1 coinfection should be considered. The objective of this study was to determine if the severity of HIV-1 infection is associated with LBW or PTD.
Abstract and Introduction
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.
Introduction
Women of child-bearing age comprise approximately half of the estimated 33.3 million people living with HIV-1. Children born to HIV-infected women have an increased risk of adverse birth outcomes, including congenital HIV-1 infection and low birthweight (LBW). Malaria is also prevalent among pregnant women, and children born to women with malaria also have an increased risk of LBW. LBW is defined as "infants born weighing <=2500 g, regardless of gestational age or cause of LBW," and it can be caused by preterm delivery (PTD, birth before 37 week's gestation), intrauterine growth restriction, or congenital/genetic abnormalities. LBW is a significant cause of infant morbidity and mortality. In 2010, PTD was the second leading cause of child deaths worldwide, and Malawi had the highest prevalence of PTD in the world.
The placenta provides fetal nourishment and serves as a barrier to fetal infection, and deficiencies in placental function are causally linked to obstetric complications. Infections that colonize the placenta, such as Plasmodium falciparum, are associated with adverse birth outcomes.Plasmodium falciparum parasites can be sequestered in the intervillous space of the placenta, and placental malaria has been associated with higher HIV-1 concentration in both peripheral and placental plasma. Our group and others have shown that HIV-1 replicates in the placenta, and it has also been shown that HIV-1 infection alters the cytokine profile in the placenta. Thus, when evaluating risk factors for adverse birth outcomes, potential interactions between malaria and HIV-1 coinfection should be considered. The objective of this study was to determine if the severity of HIV-1 infection is associated with LBW or PTD.
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