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.

Figure 1. Correlation between viral load and continuous birth weight or gestational age

Birthweight is inversely correlated with HIV-1 concentration in peripheral plasma (panel A), placental plasma (panel B). Gestational age does not correlate with HIV-1 concentration in peripheral plasma (panel C), but is inversely correlated with HIV-1 concentration in placental plasma (panel D). P-values calculated by pairwise correlation. Horizontal, black dotted lines indicate the cutoff for low birthweight (<2500 grams) or preterm birth (<37 weeks).