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Favorable pregnancy outcomes with reduction of abortion, stillbirth, and prematurity rates in a large cohort of HIV+ women in Southern Africa receiving highly active antiretroviral therapy (HAART) for prevention of mother-child-transmission (PMTCT)
Presented by Leonardo Palombi (Italy).
M.C. Marazzi1,2, L. Palombi1,3, K. Nielsen-Saines4, J. Haswell5, I. Zimba6, M. Maulidi7, N. Abdul Magid6, L. Richard5, E. Buonomo3, P. Scarcella3, S. Ceffa1, G. Paturzo1, P. Narciso8, G. Liotta3
1DREAM Program, Community of S. Egidio, Rome, Italy, 2LUMSA University, Rome, Italy, 3University of Tor Vergata, Public Health, Rome, Italy, 4UCLA, Pediatrics, Los Angeles, United States, 5DREAM Program, Community of S. Egidio, Blantyre, Malawi, 6DREAM Program, Community of S. Egidio, Maputo, Mozambique, 7DREAM Program, Community of S. Egidio, Lilongwe, Malawi, 8INMI 'L.Spallanzani', Rome, Italy
Background: Pregnancy outcomes in HIV+ women are rarely assessed in resource-limited settings. We evaluated outcomes in a large cohort receiving HAART for PMTCT purposes in Sub-Saharan Africa.
Methods: Files of 3,273 HIV+ pregnant women receiving care in Malawi and Mozambique from 7/2005 to 12/2008 at our centers were reviewed. Women were offered nevirapine-based HAART at 14 wks (if elegible for own health) or 25 wks gestation until 6 months postpartum. Abortion and stillbirths were defined as fetal death at < or ≥ 32 wks gestation.
Results: Median baseline CD4 count and viral load (VL) were 357/mm3 and 4Log c/ml. Median pregnancy duration was 39.1 wks. Median time of pre-delivery HAART was 83 days (CL95%53-108). Maternal mortality was 1.2% and significantly associated with HAART (7.4% if no HAART vs. 0.7 HAART ≥ 90 days before delivery) and CD4 threshold (3.2% vs. 0.7% if ≥ 200; p< 0.001). Abortion and stillbirth were 25.7% (18/70) in women with no HAART and 4.3% (125/2,909) in women receiving HAART for >30 days (p< 0.001). Prematurity was strongly associated with short/absent HAART: 70.8% reduction overall (Mantel-Heanszel OR=0.16; CL95%:0.12-0.21) and within each CD4 strata. Body Mass Index (OR 0.27; CL95% 0.15-0.50) and VL at delivery (OR 1.44; CL95% 1.22-1.70) were strongly associated with prematurity by multivariate analysis. Low birth weight was 11.5% and not associated with HAART duration or CD4 count.
| CD4 count | Pre-delivery HAART (days) | Premature delivery (N.) | % | OR | | >500 | <30
>30
TOTAL | 43/77
121/712
164/789 | 55.8
17.0
20.8 | 0.16
0.10-0.26 | | 351-500 | <30
>30
TOTAL | 27/56
94/661
121/717 | 48.2
14.2
16.9 | 0.18
0.10-0.31 | | 201-350 | <30
>30
TOTAL | 45/63
124/779
169/842 | 71.4
15.9
20.1 | 0.08
0.04-0.13 | | ≤200 | <30
>30
TOTAL |
10/32
85/497
95/529 | 31.3
17.1
18.0 | 0.45
0.21-0.99 |
Conclusion: HAART was strongly associated with improved pregnancy outcomes including reduction in prematurity, regardless of CD4 strata. HAART is beneficial for PMTCT AND protects against unfavorable pregnancy outcomes.
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