title: High prevalence of hypertension and placental insufficiency, but no in utero HIV transmission, among women on HAART with stillbirths in Botswana.
abstract: BACKGROUND
  Increased stillbirth rates occur among HIV-infected women, but no studies have evaluated the pathological basis for this increase, or whether highly active antiretroviral therapy (HAART) influences the etiology of stillbirths. It is also unknown whether HIV infection of the fetus is associated with stillbirth.
  
  
  METHODS
  HIV-infected women and a comparator group of HIV-uninfected women who delivered stillbirths were enrolled at the largest referral hospital in Botswana between January and November 2010. Obstetrical records, including antiretroviral use in pregnancy, were extracted at enrollment. Verbal autopsies; maternal HIV, CD4 and HIV RNA testing; stillbirth HIV PCR testing; and placental pathology (blinded to HIV and treatment status) were performed.
  
  
  RESULTS
  Ninety-nine stillbirths were evaluated, including 62 from HIV-infected women (34% on HAART from conception, 8% on HAART started in pregnancy, 23% on zidovudine started in pregnancy, and 35% on no antiretrovirals) and 37 from a comparator group of HIV-uninfected women. Only 2 (3.7%) of 53 tested stillbirths from HIV-infected women were HIV PCR positive, and both were born to women not receiving HAART. Placental insufficiency associated with hypertension accounted for most stillbirths. Placental findings consistent with chronic hypertension were common among HIV-infected women who received HAART and among HIV-uninfected women (65% vs. 54%, p = 0.37), but less common among HIV-infected women not receiving HAART (28%, p = 0.003 vs. women on HAART).
  
  
  CONCLUSIONS
  In utero HIV infection was rarely associated with stillbirths, and did not occur among women receiving HAART. Hypertension and placental insufficiency were associated with most stillbirths in this tertiary care setting.
authors.affiliation: Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America. rshapiro@hsph.harvard.edu
authors.forename: Roger L
authors.initials: RL
authors.lastname: Shapiro
authors.forename: Sajini
authors.initials: S
authors.lastname: Souda
authors.forename: Natasha
authors.initials: N
authors.lastname: Parekh
authors.forename: Kelebogile
authors.initials: K
authors.lastname: Binda
authors.forename: Mukendi
authors.initials: M
authors.lastname: Kayembe
authors.forename: Shahin
authors.initials: S
authors.lastname: Lockman
authors.forename: Petr
authors.initials: P
authors.lastname: Svab
authors.forename: Orphinah
authors.initials: O
authors.lastname: Babitseng
authors.forename: Kathleen
authors.initials: K
authors.lastname: Powis
authors.forename: William
authors.initials: W
authors.lastname: Jimbo
authors.forename: Tracy
authors.initials: T
authors.lastname: Creek
authors.forename: Joseph
authors.initials: J
authors.lastname: Makhema
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: Drucilla J
authors.initials: DJ
authors.lastname: Roberts
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015496:CD4-Positive T-Lymphocytes / Q000821:virology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology*; D018445:Infectious Disease Transmission, Vertical; D010920:Placenta / Q000473:pathology; D010927:Placental Insufficiency / Q000188:drug therapy / Q000473:pathology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D015995:Prevalence; D050497:Stillbirth
chemical_list: D019380:Anti-HIV Agents