Abstract
BackgroundDespite the recognized benefit of antiretroviral therapy (ART) for preventing and treating HIV, some studies have reported adverse birth outcomes with in utero ART exposure. We evaluated the effect of infant in utero HIV and ART exposure on preterm delivery (PTD), low birth weight (LBW), small for gestational age (SGA), and underweight for age (UFA) at 6 weeks.MethodsWe surveyed 6179 HIV-unexposed-uninfected (HUU) and 2599 HIV-exposed-uninfected (HEU) infants. HEU infants were stratified into 3 groups: ART, Zidovudine alone, and no antiretrovirals (None). The ART group was further stratified to explore pre- or postconception exposure. Multivariable logistic regression evaluated effects of HIV and ARV exposure on the outcomes.ResultsWe found higher odds of PTD, LBW, SGA, and UFA in HEU than HUU infants. HEU in the None group (adjusted odds ratio [AOR], 1.9; 95% confidence interval [CI], 1.2–3.0) or those whose mothers initiated ART preconception (AOR, 1.7; 95% CI, 1.1–2.5) had almost twice the odds of PTD than infants whose mothers started ART postconception, but no increased odds for other outcomes.ConclusionsThere was an association between preconception ART and PTD. As ART access increases, pregnancy registers or similar surveillance should be in place to monitor outcomes to inform future policy.
Highlights
Despite the recognized benefit of antiretroviral therapy (ART) for preventing and treating HIV, some studies have reported adverse birth outcomes with in utero ART exposure
HEU in the None group or those whose mothers initiated ART preconception (AOR, 1.7; 95% confidence interval (CI), 1.1–2.5) had almost twice the odds of preterm delivery (PTD) than infants whose mothers started ART postconception, but no increased odds for other outcomes
There was an association between preconception ART and PTD
Summary
We surveyed 6179 HIV-unexposed-uninfected (HUU) and 2599 HIV-exposed-uninfected (HEU) infants. HEU infants were stratified into 3 groups: ART, Zidovudine alone, and no antiretrovirals (None). The ART group was further stratified to explore pre- or postconception exposure. Multivariable logistic regression evaluated effects of HIV and ARV exposure on the outcomes. The 2012–13 South African PMTCT Evaluation (SAPMTCTE) was a nationally representative facility-based cross-sectional survey, conducted between October 2012 and May 2013, to measure vertical HIV transmission at 4–8 weeks postpartum. Under Option-A, antiretroviral drug (ARV)-naïve HIV-infected pregnant women were placed on ART (recommended tenofovir disoproxil fumarate [TDF] + [3TC]/Emtracitaine [FTC] + Nevirapine [NVP]) if CD4 cell count ≤350 cells/mm or Zidovudine (ZDV) from 14 weeks gestation (with infant NVP for 6 weeks or until 1 week postbreastfeeding) if CD4 >350 cells/mm3 [12]. Sick infants needing emergency care and those aged 8 weeks were excluded
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