Highly active antiretroviral therapy and adverse birth outcomes among HIV-infected women in Botswana.
BACKGROUND
It is unknown whether adverse birth outcomes are associated with maternal highly active antiretroviral therapy (HAART) in pregnancy, particularly in resource-limited settings.


METHODS
We abstracted obstetrical records at 6 sites in Botswana for 24 months. Outcomes included stillbirths (SBs), preterm delivery (PTD), small for gestational age (SGA), and neonatal death (NND). Among human immunodeficiency virus (HIV)-infected women, comparisons were limited to HAART exposure status at conception, and those with similar opportunities for outcomes. Comparisons were adjusted for CD4(+) lymphocyte cell count.


RESULTS
Of 33,148 women, 32,113 (97%) were tested for HIV, of whom 9504 (30%) were HIV infected. Maternal HIV was significantly associated with SB, PTD, SGA, and NND. Compared with all other HIV-infected women, those continuing HAART from before pregnancy had higher odds of PTD (adjusted odds ratio [AOR], 1.2; 95% confidence interval [CI], 1.1, 1.4), SGA (AOR, 1.8; 95% CI, 1.6, 2.1) and SB (AOR, 1.5; 95% CI, 1.2, 1.8). Among women initiating antiretroviral therapy in pregnancy, HAART use (vs zidovudine) was associated with higher odds of PTD (AOR, 1.4; 95% CI, 1.2, 1.8), SGA (AOR, 1.5; 95% CI, 1.2, 1.9), and SB (AOR, 2.5; 95% CI, 1.6, 3.9). Low CD4(+) was independently associated with SB and SGA, and maternal hypertension during pregnancy with PTD, SGA, and SB.


CONCLUSIONS
HAART receipt during pregnancy was associated with increased PTD, SGA, and SB.
Department of Medicine, Brigham and Women's Hospital, Berlin, Germany.
Jennifer Y
JY
Chen
Heather J
HJ
Ribaudo
Sajini
S
Souda
Natasha
N
Parekh
Anthony
A
Ogwu
Shahin
S
Lockman
Kathleen
K
Powis
Scott
S
Dryden-Peterson
Tracy
T
Creek
William
W
Jimbo
Tebogo
T
Madidimalo
Joseph
J
Makhema
Max
M
Essex
Roger L
RL
Shapiro
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001724:Birth Weight / Q000187:drug effects; D001902:Botswana / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D047928:Premature Birth; D012189:Retrospective Studies; D012307:Risk Factors; D050497:Stillbirth; D013997:Time Factors; D055815:Young Adult
D019380:Anti-HIV Agents