Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study)

Sufia Dadabhai, Luis Gadama, Rachel Chamanga, Rachel Kawalazira, Chaplain Katumbi, Bonus Makanani, Dingase Dula, Nan Hua, Bryan Lau, Macpherson Mallewa, Taha E. Taha

Research output: Contribution to journalArticlepeer-review

Abstract

Background:Adverse pregnancy outcomes such as preterm birth (PTB), low birth weight (LBW), and small for gestational age (SGA) remain major global problems. We compared pregnancy outcomes among HIV-infected women receiving antiretroviral treatment (ART) and with CD4 ≥350 cells, and HIV-uninfected women to assess whether disparities associated with HIV infection have been eliminated through use of ART.Setting:Observational study conducted at 5 health facilities in Blantyre, Malawi, during 2016-2017.Methods:HIV-infected women receiving the national ART regimen (efavirenz + lamivudine + tenofovir) and HIV-uninfected women were consented and enrolled at delivery. Data collected included sociodemographic and clinical; gestational age; BW; infant/maternal anthropometry; and laboratory results. We defined PTB as GA <37 weeks; LBW as BW <2·5 kg; and SGA as BW <10th percentile of GA. SGA infants were classified into proportionate and disproportionate based on ponderal index. Descriptive, stratified, and multivariate logistic and linear regression analyses were used.Results:Of 5423 women approached, 614 HIV-infected and 685 HIV-uninfected women were enrolled. Rates of PTB, LBW, and SGA were 10.6%, 7.2%, and 17.1% among HIV-infected women on ART and 9.5%, 5.0%, and 18.4% among HIV-uninfected women, respectively. None of these differences were statistically significant in univariate- or multivariate-adjusted analyses (P > 0.05). Of 231 SGA infants, 78.8% were proportionate and 21% were disproportionate. Of the 614 HIV-infected women on ART, 75% had undetectable virus at delivery.Conclusions:ART use has reduced the high rates of adverse pregnancy outcomes among HIV-infected women. However, the rates remain high irrespective of HIV infection and require appropriate interventions.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume80
Issue number1
DOIs
StatePublished - Jan 1 2019

Keywords

  • ART
  • HIV-infected women
  • HIV-uninfected women
  • pregnancy outcomes

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Fingerprint

Dive into the research topics of 'Pregnancy Outcomes in the Era of Universal Antiretroviral Treatment in Sub-Saharan Africa (POISE Study)'. Together they form a unique fingerprint.

Cite this