Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women
Identifieur interne : 003229 ( Main/Exploration ); précédent : 003228; suivant : 003230Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women
Auteurs : Hae-Young Kim [États-Unis] ; Prisca Kasonde [Zambie] ; Mwiya Mwiya [Zambie] ; Donald M. Thea [États-Unis] ; Chipepo Kankasa [Zambie] ; Moses Sinkala [Zambie] ; Grace Aldrovandi [États-Unis] ; Louise Kuhn [États-Unis]Source :
- BMC Pediatrics [ 1471-2431 ] ; 2012.
Abstract
HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth) and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status.
A total of 1229 HIV-infected pregnant women were enrolled (2001–2004) in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal (<28 days) and early mortality (<70 days) were described using Kaplan-Meier methods.
The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10–3.27) and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46–6.97), and decreasing maternal CD4 count by 100 cells/mm3 with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02–1.54). The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25–6.08). Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection.
More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to complement necessary therapeutic and prophylactic antiretroviral interventions.
Url:
DOI: 10.1186/1471-2431-12-138
PubMed: 22937874
PubMed Central: 3480840
Affiliations:
- Zambie, États-Unis
- Californie, Massachusetts, État de New York
- Boston, Los Angeles, New York
- Université Columbia, Université de Californie du Sud
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Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gertrude H. 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Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22937874</idno><idno type="pmc">3480840</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480840</idno><idno type="RBID">PMC:3480840</idno><idno type="doi">10.1186/1471-2431-12-138</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001290</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001290</idno><idno type="wicri:Area/Pmc/Curation">001289</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">001289</idno><idno type="wicri:Area/Pmc/Checkpoint">001D03</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">001D03</idno><idno type="wicri:Area/Ncbi/Merge">001914</idno><idno type="wicri:Area/Ncbi/Curation">001914</idno><idno type="wicri:Area/Ncbi/Checkpoint">001914</idno><idno type="wicri:Area/Main/Merge">003247</idno><idno type="wicri:Area/Main/Curation">003229</idno><idno type="wicri:Area/Main/Exploration">003229</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Pregnancy loss and role of infant HIV status on perinatal mortality among HIV-infected women</title><author><name sortKey="Kim, Hae Young" sort="Kim, Hae Young" uniqKey="Kim H" first="Hae-Young" last="Kim">Hae-Young Kim</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="I2">Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author><author><name sortKey="Kasonde, Prisca" sort="Kasonde, Prisca" uniqKey="Kasonde P" first="Prisca" last="Kasonde">Prisca Kasonde</name><affiliation wicri:level="1"><nlm:aff id="I3">University Teaching Hospital, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University Teaching Hospital, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Mwiya, Mwiya" sort="Mwiya, Mwiya" uniqKey="Mwiya M" first="Mwiya" last="Mwiya">Mwiya Mwiya</name><affiliation wicri:level="1"><nlm:aff id="I3">University Teaching Hospital, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University Teaching Hospital, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Thea, Donald M" sort="Thea, Donald M" uniqKey="Thea D" first="Donald M" last="Thea">Donald M. Thea</name><affiliation wicri:level="3"><nlm:aff id="I4">Center for International Health and Development, Boston University of School of Public Health, Boston, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for International Health and Development, Boston University of School of Public Health, Boston</wicri:regionArea><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName></affiliation></author><author><name sortKey="Kankasa, Chipepo" sort="Kankasa, Chipepo" uniqKey="Kankasa C" first="Chipepo" last="Kankasa">Chipepo Kankasa</name><affiliation wicri:level="1"><nlm:aff id="I3">University Teaching Hospital, University of Zambia, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>University Teaching Hospital, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Sinkala, Moses" sort="Sinkala, Moses" uniqKey="Sinkala M" first="Moses" last="Sinkala">Moses Sinkala</name><affiliation wicri:level="1"><nlm:aff id="I5">Lusaka District Health Management Team, Lusaka, Zambia</nlm:aff><country xml:lang="fr">Zambie</country><wicri:regionArea>Lusaka District Health Management Team, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Aldrovandi, Grace" sort="Aldrovandi, Grace" uniqKey="Aldrovandi G" first="Grace" last="Aldrovandi">Grace Aldrovandi</name><affiliation wicri:level="4"><nlm:aff id="I6">Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Children's Hospital Los Angeles, University of Southern California, Los Angeles</wicri:regionArea><placeName><settlement type="city">Los Angeles</settlement><region type="state">Californie</region><settlement type="city">Los Angeles</settlement></placeName><orgName type="university">Université de Californie du Sud</orgName></affiliation></author><author><name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name><affiliation wicri:level="4"><nlm:aff id="I1">Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation><affiliation wicri:level="4"><nlm:aff id="I2">Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY</wicri:regionArea><placeName><region type="state">État de New York</region><settlement type="city">New York</settlement></placeName><orgName type="university">Université Columbia</orgName></affiliation></author></analytic><series><title level="j">BMC Pediatrics</title><idno type="eISSN">1471-2431</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>HIV-infected women, particularly those with advanced disease, may have higher rates of pregnancy loss (miscarriage and stillbirth) and neonatal mortality than uninfected women. Here we examine risk factors for these adverse pregnancy outcomes in a cohort of HIV-infected women in Zambia considering the impact of infant HIV status.</p></sec><sec><title>Methods</title><p>A total of 1229 HIV-infected pregnant women were enrolled (2001–2004) in Lusaka, Zambia and followed to pregnancy outcome. Live-born infants were tested for HIV by PCR at birth, 1 week and 5 weeks. Obstetric and neonatal data were collected after delivery and the rates of neonatal (<28 days) and early mortality (<70 days) were described using Kaplan-Meier methods.</p></sec><sec><title>Results</title><p>The ratio of miscarriage and stillbirth per 100 live-births were 3.1 and 2.6, respectively. Higher maternal plasma viral load (adjusted odds ratio [AOR] for each log10 increase in HIV RNA copies/ml = 1.90; 95% confidence interval [CI] 1.10–3.27) and being symptomatic were associated with an increased risk of stillbirth (AOR = 3.19; 95% CI 1.46–6.97), and decreasing maternal CD4 count by 100 cells/mm<sup>3</sup> with an increased risk of miscarriage (OR = 1.25; 95% CI 1.02–1.54). The neonatal mortality rate was 4.3 per 100 increasing to 6.3 by 70 days. Intrauterine HIV infection was not associated with neonatal morality but became associated with mortality through 70 days (adjusted hazard ratio = 2.76; 95% CI 1.25–6.08). Low birth weight and cessation of breastfeeding were significant risk factors for both neonatal and early mortality independent of infant HIV infection.</p></sec><sec><title>Conclusions</title><p>More advanced maternal HIV disease was associated with adverse pregnancy outcomes. Excess neonatal mortality in HIV-infected women was not primarily explained by infant HIV infection but was strongly associated with low birth weight and prematurity. Intrauterine HIV infection contributed to mortality as early as 70 days of infant age. Interventions to improve pregnancy outcomes for HIV-infected women are needed to complement necessary therapeutic and prophylactic antiretroviral interventions.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Brocklehurst, P" uniqKey="Brocklehurst P">P Brocklehurst</name></author><author><name sortKey="French, R" uniqKey="French R">R French</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chi, Bh" uniqKey="Chi B">BH Chi</name></author><author><name sortKey="Wang, L" uniqKey="Wang L">L Wang</name></author><author><name sortKey="Read, Js" uniqKey="Read J">JS Read</name></author><author><name sortKey="Taha, Te" uniqKey="Taha T">TE Taha</name></author><author><name sortKey="Sinkala, M" uniqKey="Sinkala M">M Sinkala</name></author><author><name sortKey="Brown, Er" uniqKey="Brown E">ER Brown</name></author><author><name sortKey="Valentine, M" uniqKey="Valentine M">M 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Mehta</name></author><author><name sortKey="Manji, Kp" uniqKey="Manji K">KP Manji</name></author><author><name sortKey="Young, Am" uniqKey="Young A">AM Young</name></author><author><name sortKey="Brown, Er" uniqKey="Brown E">ER Brown</name></author><author><name sortKey="Chasela, C" uniqKey="Chasela C">C Chasela</name></author><author><name sortKey="Taha, Te" uniqKey="Taha T">TE Taha</name></author><author><name sortKey="Read, Js" uniqKey="Read J">JS Read</name></author><author><name sortKey="Goldenberg, Rl" uniqKey="Goldenberg R">RL Goldenberg</name></author><author><name sortKey="Fawzi, Ww" uniqKey="Fawzi W">WW Fawzi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fawzi, Ww" uniqKey="Fawzi W">WW Fawzi</name></author><author><name sortKey="Msamanga, Gi" uniqKey="Msamanga G">GI Msamanga</name></author><author><name sortKey="Spiegelman, D" uniqKey="Spiegelman D">D Spiegelman</name></author><author><name sortKey="Urassa, Ejn" uniqKey="Urassa E">EJN Urassa</name></author><author><name sortKey="Mcgrath, N" uniqKey="Mcgrath N">N McGrath</name></author><author><name sortKey="Mwakagile, D" uniqKey="Mwakagile D">D Mwakagile</name></author><author><name sortKey="Antelman, G" uniqKey="Antelman G">G Antelman</name></author><author><name sortKey="Mbise, R" uniqKey="Mbise R">R Mbise</name></author><author><name sortKey="Herrera, G" uniqKey="Herrera G">G Herrera</name></author><author><name sortKey="Kapiga, S" uniqKey="Kapiga S">S Kapiga</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Olausson, Po" uniqKey="Olausson P">PO Olausson</name></author><author><name sortKey="Cnattingius, S" uniqKey="Cnattingius S">S Cnattingius</name></author><author><name sortKey="Haglund, B" uniqKey="Haglund B">B Haglund</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gilbert, Wm" uniqKey="Gilbert W">WM Gilbert</name></author><author><name sortKey="Jandial, D" uniqKey="Jandial D">D Jandial</name></author><author><name sortKey="Field, Nt" uniqKey="Field N">NT Field</name></author><author><name sortKey="Bigelow, P" uniqKey="Bigelow P">P Bigelow</name></author><author><name sortKey="Danielsen, B" uniqKey="Danielsen B">B Danielsen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, X K" uniqKey="Chen X">X-K Chen</name></author><author><name sortKey="Wen, Sw" uniqKey="Wen S">SW Wen</name></author><author><name sortKey="Fleming, N" uniqKey="Fleming N">N Fleming</name></author><author><name sortKey="Yang, Q" uniqKey="Yang Q">Q Yang</name></author><author><name sortKey="Walker, Mc" uniqKey="Walker M">MC Walker</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Smith, Gcs" uniqKey="Smith G">GCS Smith</name></author><author><name sortKey="Pell, Jp" uniqKey="Pell J">JP Pell</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kline, J" uniqKey="Kline J">J Kline</name></author><author><name sortKey="Stein, Z" uniqKey="Stein Z">Z Stein</name></author><author><name sortKey="Susser, M" uniqKey="Susser M">M Susser</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Zambie</li><li>États-Unis</li></country><region><li>Californie</li><li>Massachusetts</li><li>État de New York</li></region><settlement><li>Boston</li><li>Los Angeles</li><li>New York</li></settlement><orgName><li>Université Columbia</li><li>Université de Californie du Sud</li></orgName></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="Kim, Hae Young" sort="Kim, Hae Young" uniqKey="Kim H" first="Hae-Young" last="Kim">Hae-Young Kim</name></region><name sortKey="Aldrovandi, Grace" sort="Aldrovandi, Grace" uniqKey="Aldrovandi G" first="Grace" last="Aldrovandi">Grace Aldrovandi</name><name sortKey="Kim, Hae Young" sort="Kim, Hae Young" uniqKey="Kim H" first="Hae-Young" last="Kim">Hae-Young Kim</name><name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name><name sortKey="Kuhn, Louise" sort="Kuhn, Louise" uniqKey="Kuhn L" first="Louise" last="Kuhn">Louise Kuhn</name><name sortKey="Thea, Donald M" sort="Thea, Donald M" uniqKey="Thea D" first="Donald M" last="Thea">Donald M. Thea</name></country><country name="Zambie"><noRegion><name sortKey="Kasonde, Prisca" sort="Kasonde, Prisca" uniqKey="Kasonde P" first="Prisca" last="Kasonde">Prisca Kasonde</name></noRegion><name sortKey="Kankasa, Chipepo" sort="Kankasa, Chipepo" uniqKey="Kankasa C" first="Chipepo" last="Kankasa">Chipepo Kankasa</name><name sortKey="Mwiya, Mwiya" sort="Mwiya, Mwiya" uniqKey="Mwiya M" first="Mwiya" last="Mwiya">Mwiya Mwiya</name><name sortKey="Sinkala, Moses" sort="Sinkala, Moses" uniqKey="Sinkala M" first="Moses" last="Sinkala">Moses Sinkala</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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