Cassandra R Duffy, Julie M Herlihy, Ethan Zulu, Lawrence Mwananyanda, Leah Forman, Tim Heeren, Christopher J Gill, Megan Harper, Roma Chilengi, Roy Chavuma, Barbara Payne-Lohman, Donald M Thea
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Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.</p><p><strong>Design: </strong>Prospective observational cohort.</p><p><strong>Setting: </strong>Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.</p><p><strong>Participants: </strong>A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.</p><p><strong>Methods: </strong>From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis.</p><p><strong>Main outcome measures: </strong>PTB (<37 weeks) and SGA.</p><p><strong>Results: </strong>There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection.</p><p><strong>Conclusions: </strong>HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.</p>","PeriodicalId":7502,"journal":{"name":"AIDS","volume":" ","pages":"1749-1757"},"PeriodicalIF":3.4000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11356690/pdf/","citationCount":"0","resultStr":"{\"title\":\"Preterm birth among women with HIV: impact of preconception cART initiation.\",\"authors\":\"Cassandra R Duffy, Julie M Herlihy, Ethan Zulu, Lawrence Mwananyanda, Leah Forman, Tim Heeren, Christopher J Gill, Megan Harper, Roma Chilengi, Roy Chavuma, Barbara Payne-Lohman, Donald M Thea\",\"doi\":\"10.1097/QAD.0000000000003979\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.</p><p><strong>Design: </strong>Prospective observational cohort.</p><p><strong>Setting: </strong>Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.</p><p><strong>Participants: </strong>A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.</p><p><strong>Methods: </strong>From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. 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引用次数: 0
摘要
目的与未感染艾滋病病毒的妇女相比，研究感染艾滋病病毒的妇女早产（PTB）和胎龄小（SGA）的风险。次要目标是探讨母体免疫激活（IA）的作用以及 cART 时间对这些结果的影响：设计：前瞻性观察队列：地点：赞比亚卢萨卡 Chawama 医院由政府运营的城市诊所：1481名感染和未感染艾滋病毒的单胎妊娠妇女在妊娠26周前通过超声波测孕登记：方法：2019 年 8 月至 2022 年 11 月，按照 1:1 的 HIV 感染比例招募孕妇。收集了母体基线临床因素，以及感染 HIV 妇女的 CD4、病毒载量和 CD8 T 细胞 IA。此外，还收集了分娩结果。通过多变量逻辑回归评估了 HIV 暴露和 cART 时间与预后的关系。通过中介分析确定IA的独立作用：PTB（结果：38例胎儿死亡，1230例单胎活产。母体艾滋病病毒感染与 PTB 相关（AOR 1.60，95%CI 1.11-2.32），其次与 SGA 相关（AOR 1.29，0.98-1.70）。孕产妇开始 cART 的时间对这些相关性有影响，受孕后开始 cART 的妇女风险最高（PTB AOR 1.77，95%CI 1.09-2.87；SGA AOR 1.52，95%CI 1.04-2.22）。产妇 IA 与 PTB 无关，与 HIV 感染无关：结论：HIV 与 PTB 相关。在妊娠期开始接受 cART 治疗的女性艾滋病毒感染者中，PTB 和 SGA 的风险最高，这是一个可改变的风险因素。
Preterm birth among women with HIV: impact of preconception cART initiation.
Objective: To examine the risk of preterm birth (PTB) and small for gestational age (SGA) among women with HIV compared to women without HIV. Secondary objectives were to explore the role of maternal immune activation (IA) and effect of cART timing on these outcomes.
Design: Prospective observational cohort.
Setting: Urban government-run clinic at Chawama Hospital in Lusaka, Zambia.
Participants: A total of 1481 women with and without HIV with singleton pregnancies enrolled before 26 weeks' gestation by ultrasound dating.
Methods: From August 2019 to November 2022, pregnant women were enrolled in a 1 : 1 ratio of HIV infection. Maternal baseline clinical factors were collected, as well as CD4 + , viral load and CD8 + T-cell IA in women with HIV. Birth outcomes were also collected. The association of HIV-exposure and cART timing on outcomes was assessed by multivariable logistic regression. The independent role of IA was determined by mediation analysis.
Main outcome measures: PTB (<37 weeks) and SGA.
Results: There were 38 fetal deaths and 1230 singleton live births. Maternal HIV infection was associated with PTB [adjusted odds ratio (AOR) 1.60, 95% confidence interval (CI) 1.11-2.32] and to a lesser extent SGA (AOR 1.29, 95% CI 0.98-1.70). Maternal cART timing impacted these associations, with highest risk in women who started cART after conception (PTB AOR 1.77, 95% CI 1.09-2.87, SGA AOR 1.52, 95% CI 1.04-2.22). Maternal IA was not associated with PTB independent of HIV infection.
Conclusions: HIV is associated with PTB. Risk of PTB and SGA was highest in women with HIV who started cART in pregnancy, a modifiable risk factor.
期刊介绍：
Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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