title: Severity of maternal HIV-1 disease is associated with adverse birth outcomes in Malawian women: a cohort study.
abstract: BACKGROUND
  Compared with HIV-negative women, HIV-infected women have increased risk of low birthweight (LBW) and preterm delivery (PTD). We assessed whether severity of maternal HIV-1 disease was associated with LBW or PTD.
  
  
  METHODS
  Secondary analysis of The Malaria and HIV in Pregnancy prospective cohort, which enrolled HIV-positive, pregnant Malawian women from 2000 to 2004. Included participants (n = 809) were normotensive antiretroviral treatment-naive women who delivered a live singleton infant. Binomial regression models were used to assess the unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) of the effect of severity of HIV-1 disease, defined by viral load and CD4 T-cell counts, on prevalence of LBW and PTD.
  
  
  RESULTS
  In unadjusted analyses, among those with malaria (n = 198), there was no association between severity of HIV-1 infection and LBW, whereas among women without malaria (n = 611), we observed a harmful association between both increasing peripheral viral load and LBW (PR: 1.44 per 1-log10 increase, 95% CI: 1.12 to 1.86) and placental viral load and LBW (PR: 1.24 per 1-log10 increase, 95% CI: 1.00 to 1.53). We observed a similar association between increasing placental viral load and PTD (PR: 1.33 per one-log10 increase, 95% CI: 1.04 to 1.69). These associations persisted in multivariate models adjusted for residence, maternal education, primigravid status, and maternal anemia.
  
  
  CONCLUSIONS
  In malaria-negative women, maternal HIV-1 disease severity was significantly associated with increased prevalence of LBW and PTD. Such an association was not found in the malaria-infected women.
authors.affiliation: *Division of Infectious Diseases, Department of Medicine, Center for Microbial Interface Biology, and Public Health Preparedness for Infectious Diseases Program, Ohio State University, Columbus, OH; †Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH; ‡Department of Obstetrics and Gynecology, College of Medicine, Ohio State University, Columbus, OH; §Department of Community Health, Malawi College of Medicine, Blantyre, Malawi; ‖Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; ¶Department of Epidemiology, University of North Carolina, Chapel Hill, NC; and #Departments of Microbial Infection and Immunity and Microbiology, and Center for Retrovirus Research, Ohio State University, Columbus, OH.
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
authors.forename: Sammy
authors.initials: S
authors.lastname: Tabbah
authors.forename: Victor
authors.initials: V
authors.lastname: Mwapasa
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rogerson
authors.forename: Steven R
authors.initials: SR
authors.lastname: Meshnick
authors.forename: William E
authors.initials: WE
authors.lastname: Ackerman
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Kwiek
mesh_terms: D000328:Adult; D002821:Chorioamnionitis; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D015497:HIV-1; D006801:Humans; D007230:Infant, Low Birth Weight; D008295:Malawi / Q000453:epidemiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000473:pathology*; D047928:Premature Birth; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult