title: Effect of highly active antiretroviral treatment (HAART) during pregnancy on pregnancy outcomes: experiences from a PMTCT program in western India.
abstract: Previous research regarding the effect of highly active antiretroviral treatment (HAART) on pregnancy outcomes shows conflicting results and is predominantly situated in developed countries. Recently, HAART is rapidly being scaled up in developing countries for prevention of mother-to-child transmission (PMTCT). This study compared adverse pregnancy outcomes among HIV infected women (N=516) who received either HAART (N=192)--mostly without protease inhibitor--or antepartum azidothymidine (AZT) with intrapartum nevirapine (N=324) from January 2008 to March 2012 through a PMTCT program in western India. We analyzed the effect of HAART on preterm births, low birth weight, and all adverse pregnancy outcomes combined using univariate and multivariate logistic regression models. Women on HAART had 48% adverse pregnancy outcomes, 25% preterm births, and 34% low birth weight children compared to respectively 32%, 13%, and 22% among women on AZT. Women receiving HAART were more likely to have adverse pregnancy outcomes and preterm births compared to women receiving AZT. Preconception HAART was significantly related to low birth weight children. This study demonstrated increased risk of adverse pregnancy outcomes with protease inhibitor excluded HAART. Prospective studies assessing the impact of HAART on MTCT as measured in terms of HIV-free survival among children are needed.
authors.affiliation: Faculty of Spatial Sciences, Population Research Centre, University of Groningen, The Netherlands. shirishdarak@gmail.com
authors.forename: Shrinivas
authors.initials: S
authors.lastname: Darak
authors.forename: Trupti
authors.initials: T
authors.lastname: Darak
authors.forename: Sanjeevani
authors.initials: S
authors.lastname: Kulkarni
authors.forename: Vinay
authors.initials: V
authors.lastname: Kulkarni
authors.forename: Ritu
authors.initials: R
authors.lastname: Parchure
authors.forename: Inge
authors.initials: I
authors.lastname: Hutter
authors.forename: Fanny
authors.initials: F
authors.lastname: Janssen
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D018791:CD4 Lymphocyte Count; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D006801:Humans; D007194:India; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D016015:Logistic Models; D019829:Nevirapine / Q000009:adverse effects / Q000627:therapeutic use*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011256:Pregnancy Outcome; D047928:Premature Birth; D015397:Program Evaluation; D011446:Prospective Studies; D012959:Socioeconomic Factors; D019562:Viral Load; D055815:Young Adult; D015215:Zidovudine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D019380:Anti-HIV Agents; D015215:Zidovudine; D019829:Nevirapine