Association of HIV infection with spontaneous and iatrogenic preterm delivery:  effect of HAART.
OBJECTIVE
To assess the association between HIV infection and both spontaneous and iatrogenic preterm delivery (PTD), and to explore the impact of HAART on both entities.


METHODS
A matched retrospective cohort study was carried out on 517 HIV-infected pregnant women who consecutively attended a university referral hospital between 1986 and 2010. Two controls were assigned for each case. They were matched by ethnicity, smoking, maternal age and educational level. Exclusion criteria were multiple pregnancy and active injection drug use (IDU). PTD was defined as delivery less than 37.0 weeks. Spontaneous PTD included preterm premature rupture of membranes. Iatrogenic delivery was considered if medically indicated. Factors associated with PTD among HIV-infected women were analyzed by logistic regression.


RESULTS
A total of 1557 pregnant women were analyzed (519 HIV-infected and 1038 noninfected). The incidence of PTD was 19.7% in HIV-infected women and 8.5% in controls [odds ratio (OR) 2.6; 95% CI 1.9-3.6]. There was a significantly higher incidence of both spontaneous [adjusted OR (AOR) 2.1; 95% confidence interval (CI) 1.5-3.0] and iatrogenic prematurity (AOR 3.2; 95% CI 1.8-5.7). Iatrogenic PTD was significantly associated with the use of HAART during the second half of pregnancy, whereas spontaneous PTD was not related to HAART.


CONCLUSIONS
There is a significant association of HIV infection with PTD, both spontaneous and iatrogenic PTD. HAART use was predominantly associated with iatrogenic PTD.
Maternal-Fetal Medicine Department, Institut Clinic de Ginecologia, Obstetricia i Neonatologia, Barcelona, Spain. lopezro@clinic.ub.es
Marta
M
Lopez
Francesc
F
Figueras
Sandra
S
Hernandez
Montserrat
M
Lonca
Raul
R
Garcia
Montse
M
Palacio
Oriol
O
Coll
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000209:etiology* / Q000821:virology; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology