Abstract
This study determined risk factors, obstetric comorbidities, and fetal conditions among HIV-positive mothers to improve their maternal care. This retrospective case-control study included HIV-positive pregnant women 18 years of age or older and age-, parity-, and delivery method-matched HIV-negative controls between 2011 and 2018. Those who had stillbirth were excluded. Baseline demographics, labor process, CD4 count, plasma HIV viral load, and antiretroviral therapy (ART) regimen were recorded. Fetal conditions were recorded as well. Forty HIV-positive women (45 parities; 22 via NSD, 23 via C/S) were included, with 45 HIV-negative parities as controls. Twenty-nine (72.5%) HIV-positive women had illicit drug use. In the HIV-positive group, 17% received ART prior to first perinatal visit, and 75.6% reached viral suppression pre-delivery. Zidovudine and ritonavir-boosted lopinavir were the majorly prescribed ART. Mild perineal lacerations via NSD were observed in HIV-positive women. Fetal body weight was lower in HIV- and ART-exposed fetuses (2665 vs 3010 g, p < 0.001). Preterm delivery PTB (28.9% vs 8.9%, p= 0.015) and small-for gestational age SGA (28.9% vs 8.8%, p = 0.003) rates were higher in the HIV-positive group. There was no vertical transmission of HIV. HIV-positive women tend to deliver fetuses with low body weight and have higher SGA and PTB rates. Given that most women received zidovudine and protease inhibitors, benefits of newer agents for HIV-positive pregnancies should be studied.
Highlights
This study determined risk factors, obstetric comorbidities, and fetal conditions among human immunodeficiency virus (HIV)-positive mothers to improve their maternal care
Worldwide human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemics has resulted in 35 million deaths for the past 35 years [1], and there are approximately 36.7 million people living with HIV (0.8% of the global adult population aged 15-49 years) in 2016 [2], with more than half of them being women
We aimed to determine the characteristics, obstetric morbidities, and fetal conditions and complications of pregnant women with HIV infection, and to compare these to those of HIV-negative controls to improve their maternal care. This case-control observational study was conducted at Taoyuan General Hospital (TYGH), a 1,000-bed hospital located in northern Taiwan (Figure 1)
Summary
This study determined risk factors, obstetric comorbidities, and fetal conditions among HIV-positive mothers to improve their maternal care. Methodology: This retrospective case-control study included HIV-positive pregnant women 18 years of age or older and age-, parity-, and delivery method-matched HIV-negative controls between 2011 and 2018. Conclusions: HIV-positive women tend to deliver fetuses with low body weight and have higher SGA and PTB rates. New HIV infection rates are declining because of global efforts to strengthen HIV prevention and treatment programs, and especially, in children aged 15 years of age or younger, infections have declined to 47% since 2010 owing to the provision of antiretroviral therapy (ART) to pregnant women, increasing from 47% [38%–55%] to 76% [60%–88%] over the same period. According to the Taiwan Centers for Disease Control PMTCT programs, Hung et al – HIV+ pregnancy and ART- and HIV-exposed fetus
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