title: Antiretroviral therapy in pregnant women with advanced HIV disease and pregnancy outcomes in Abidjan, Côte d'Ivoire.
abstract: BACKGROUND
  Pregnancy outcomes in women receiving highly active antiretroviral treatment (HAART) in Africa are not well described.
  
  
  METHODS
  HIV-1-infected pregnant women in the ANRS Ditrame Plus and the MTCT-Plus projects were included. Between March 2001 and July 2003, when HAART was not yet available, women eligible for HAART received a short-course antiretroviral regimen, zidovudine (ZDV) or (ZDV + lamivudine) and single dose of nevirapine for preventing mother-to-child transmission (PMTCT group). Between August 2003 and August 2007, eligible women for HAART received it (HAART group). The frequencies of low birth weight (LBW) (<2500 g), stillbirth and infant mortality are reported. Risk factors associated with LBW were investigated using a logistic regression model.
  
  
  RESULTS
  Of the 326 HIV-infected pregnant women, 175 women received short-course antiretroviral (median CD4 cell count 177 cells/microl) and 151 received HAART (median CD4 cell count 182 cells/microl). At 12 months, three paediatric infections (2.3%) occurred in the HAART group vs. 25 (16.1%) in the PMTCT group (P < 0.001). The rate of LBW was 22.3% in the HAART group and 12.4% in the PMTCT group (P = 0.02). In multivariable analysis (n = 309), after adjustment on maternal CD4 cell count, WHO stage, age and maternal BMI, HAART initiated before pregnancy [adjusted odds ratio (OR) 2.88, 95% confidence interval (CI) 1.10-7.51] and during pregnancy (adjusted OR 2.12, 95% CI 1.15-4.65) and maternal BMI at delivery (adjusted OR 2.43, 95% CI 1.20-4.91) were associated with LBW.
  
  
  CONCLUSIONS
  HAART in pregnant African women with advanced HIV disease substantially reduced mother-to-child transmission, but was associated with LBW.
authors.affiliation: ANRS 1201/1202 DITRAME PLUS Project, PACCI Collaboration, Abidjan, Côte d'Ivoire, France. ekouevi@aviso.ci
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Coffie
authors.forename: Renaud
authors.initials: R
authors.lastname: Becquet
authors.forename: Besigin
authors.initials: B
authors.lastname: Tonwe-Gold
authors.forename: Appolinaire
authors.initials: A
authors.lastname: Horo
authors.forename: Rodolphe
authors.initials: R
authors.lastname: Thiebaut
authors.forename: Valériane
authors.initials: V
authors.lastname: Leroy
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
authors.forename: François
authors.initials: F
authors.lastname: Dabis
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams