Effects of the timing of maternal antiretroviral therapy initiation, CD4 count, and HIV viral load on birth outcomes in the Eastern Cape province of South Africa: A secondary data analysis

Background

Antiretroviral therapy (ART) use during pregnancy is essential to prevent vertical transmission of HIV, but it may also increase the risk of adverse birth outcomes. This study investigated the impact of both maternal HIV infection and the timing of ART initiation on birth outcomes in women living with HIV in South Africa.

Methods

This secondary data analysis examined the dataset from an earlier cohort study involving 1709 pregnant women living with HIV who delivered their babies at three major maternity centres in the Eastern Cape province of South Africa between September 2015 and May 2018. The associations between adverse birth outcomes (stillbirth, preterm birth, very preterm birth, and low birth weight) and the timing of maternal ART initiation, peripartum CD4 count, and HIV viral load were examined using logistic regression analysis.

Results

The observed rates of stillbirth, preterm birth, very preterm birth, and low birth weight were 1.4%, 33.5%, 5.4% and 18.0%, respectively. In the multivariable analysis, low birth weight was associated with ART initiated during the second trimester (adjusted odds ratio [aOR] 1.38; 95% confidence interval [CI], 1.03–1.85), low-level viraemia (21–999 copies/ml) (aOR, 1.62; 95% CI, 1.17–2.22), and high-level viraemia (≥1000 copies/ml) (aOR, 1.66; 95% CI, 1.66–2.38) during the peripartum period. Preterm birth was associated with low-level viraemia (aOR, 1.44; 95% CI, 1.16–1.79) and a CD4 count of less than 200 cells/mm3 (aOR, 1.35; 95% CI, 1.01–1.82). Very preterm birth was associated with detectable maternal viraemia.

Conclusion

Adverse birth outcomes are common among pregnant women living with HIV, especially those with unsuppressed viraemia. Clinicians and programme managers should prioritise timeous ART initiation and virological suppression in all pregnant women living with HIV.