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Duration of cART Before Delivery and Low Infant Birthweight among Hiv-infected Women in Lusaka, Zambia

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Duration of cART Before Delivery and Low Infant Birthweight among Hiv-infected Women in Lusaka, Zambia

Auteurs : Angela M. Bengtson ; Carla J. Chibwesha ; Daniel Westreich ; Mwangelwa Mubiana-Mbewe ; Bellington Vwalika [Zambie] ; William C. Miller ; Muntanga Mapani ; Patrick Musonda [Zambie] ; Audrey Pettifor ; Benjamin H. Chi

Source :

Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2016.

RBID : PMC:4788590

Abstract

Objective

To estimate the association between duration of combination antiretroviral therapy (cART) during pregnancy and low infant birthweight (LBW), among women ≥37 weeks gestation.

Design

We conducted a retrospective cohort study of HIV-infected women who met eligibility criteria based on CD4 count ≤350 but had not started cART at entry into antenatal care (ANC). Our cohort was restricted to births that occurred ≥37 weeks gestation.

Methods

We used Poisson models with robust variance estimators to estimate risk ratios (RR) and 95% confidence intervals (CI).

Results

Of 50,765 HIV-infected women with antenatal visits between January 2009 and September 2013, 4,474 women met the inclusion criteria. LBW occurred in 302 pregnancies (7%). Nearly two-thirds of women (62%) eligible to initiate cART never started treatment. Overall, 14% were on cART for ≤8 weeks, 22% for 9-20 weeks, and 2% for 21-36 weeks. There was no evidence of an increased risk of LBW for women receiving cART for ≤8 weeks (RR 1.22, 95% CI: 0.77, 1.91), 9-20 weeks (RR 1.23, 95% CI: 0.82, 1.83), or 21-36 weeks (RR 0.87, 95% CI: 0.22, 3.46), compared to women who never initiated treatment. These findings were consistent across several sensitivity analyses.

Conclusions

Longer duration of cART was not associated with poor fetal growth among term pregnancies in our cohort. However, the relationship between cART and adverse pregnancy outcomes remains complicated. Continued work is required to investigate causality. An understanding cART's impact on adverse pregnancy outcomes is essential as cART becomes the cornerstone of PMTCT programs globally.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4788590

DOI: 10.1097/QAI.0000000000000909
PubMed: 26627103
PubMed Central: 4788590

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Angela M. Bengtson

<affiliation><nlm:aff id="A1">Department of Epidemiology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

<affiliation><nlm:aff id="A2">Centre for Infectious Disease Research in Zambia</nlm:aff>
</affiliation>

Carla J. Chibwesha

<affiliation><nlm:aff id="A3">Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

Daniel Westreich

<affiliation><nlm:aff id="A1">Department of Epidemiology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

William C. Miller

<affiliation><nlm:aff id="A1">Department of Epidemiology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

<affiliation><nlm:aff id="A5">Department of Medicine, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

William C. Miller

<affiliation><nlm:aff id="A5">Department of Medicine, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

Audrey Pettifor

<affiliation><nlm:aff id="A1">Department of Epidemiology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

Benjamin H. Chi

<affiliation><nlm:aff id="A3">Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>

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<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
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<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
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<author><name sortKey="Miller, William C" sort="Miller, William C" uniqKey="Miller W" first="William C." last="Miller">William C. Miller</name>
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<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
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<affiliation><nlm:aff id="A5">Department of Medicine, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
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<author><name sortKey="Mapani, Muntanga" sort="Mapani, Muntanga" uniqKey="Mapani M" first="Muntanga" last="Mapani">Muntanga Mapani</name>
<affiliation><nlm:aff id="A2">Centre for Infectious Disease Research in Zambia</nlm:aff>
</affiliation>
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<author><name sortKey="Musonda, Patrick" sort="Musonda, Patrick" uniqKey="Musonda P" first="Patrick" last="Musonda">Patrick Musonda</name>
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<wicri:regionArea>University of Zambia, Lusaka</wicri:regionArea>
<wicri:noRegion>Lusaka</wicri:noRegion>
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<author><name sortKey="Pettifor, Audrey" sort="Pettifor, Audrey" uniqKey="Pettifor A" first="Audrey" last="Pettifor">Audrey Pettifor</name>
<affiliation><nlm:aff id="A1">Department of Epidemiology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
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</author>
<author><name sortKey="Chi, Benjamin H" sort="Chi, Benjamin H" uniqKey="Chi B" first="Benjamin H." last="Chi">Benjamin H. Chi</name>
<affiliation><nlm:aff id="A2">Centre for Infectious Disease Research in Zambia</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill</nlm:aff>
<wicri:noCountry code="subfield">University of North Carolina-Chapel Hill</wicri:noCountry>
</affiliation>
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<series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title>
<idno type="ISSN">1525-4135</idno>
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<imprint><date when="2016">2016</date>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P1">To estimate the association between duration of combination antiretroviral therapy (cART) during pregnancy and low infant birthweight (LBW), among women ≥37 weeks gestation.</p>
</sec>
<sec id="S2"><title>Design</title>
<p id="P2">We conducted a retrospective cohort study of HIV-infected women who met eligibility criteria based on CD4 count ≤350 but had not started cART at entry into antenatal care (ANC). Our cohort was restricted to births that occurred ≥37 weeks gestation.</p>
</sec>
<sec id="S3"><title>Methods</title>
<p id="P3">We used Poisson models with robust variance estimators to estimate risk ratios (RR) and 95% confidence intervals (CI).</p>
</sec>
<sec id="S4"><title>Results</title>
<p id="P4">Of 50,765 HIV-infected women with antenatal visits between January 2009 and September 2013, 4,474 women met the inclusion criteria. LBW occurred in 302 pregnancies (7%). Nearly two-thirds of women (62%) eligible to initiate cART never started treatment. Overall, 14% were on cART for ≤8 weeks, 22% for 9-20 weeks, and 2% for 21-36 weeks. There was no evidence of an increased risk of LBW for women receiving cART for ≤8 weeks (RR 1.22, 95% CI: 0.77, 1.91), 9-20 weeks (RR 1.23, 95% CI: 0.82, 1.83), or 21-36 weeks (RR 0.87, 95% CI: 0.22, 3.46), compared to women who never initiated treatment. These findings were consistent across several sensitivity analyses.</p>
</sec>
<sec id="S5"><title>Conclusions</title>
<p id="P5">Longer duration of cART was not associated with poor fetal growth among term pregnancies in our cohort. However, the relationship between cART and adverse pregnancy outcomes remains complicated. Continued work is required to investigate causality. An understanding cART's impact on adverse pregnancy outcomes is essential as cART becomes the cornerstone of PMTCT programs globally.</p>
</sec>
</div>
</front>
</TEI>
</record>

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Duration of cART Before Delivery and Low Infant Birthweight among Hiv-infected Women in Lusaka, Zambia

Duration of cART Before Delivery and Low Infant Birthweight among Hiv-infected Women in Lusaka, Zambia

Source :

Abstract

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