3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

PREGNANCY OUTCOMES IN HIV-INFECTED AND UNINFECTED WOMEN IN URBAN AND RURAL SOUTH AFRICA

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuPp0401

Rollins N.¹, Coovadia H.², van den Broeck J.³, Bland R.³, Bennish M.³, Newell M.L.⁴, for the Vertical Transmission Study ^3
1 Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa, ² Centre for HIV/AIDS Networking (HIVAN), University of KwaZulu-Natal, Durban, South Africa, ³ Africa Centre for Health and Population Studies, Somkhele, South Africa, ⁴ Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, United Kingdom

INTRODUCTION: To inform the debate on pregnancy outcome in high HIV seroprevalence African settings, we present preliminary findings from a prospective mother-to-child transmission and infant feeding practices study.

METHODS: Pregnant women attending 8 rural and 1 urban antenatal clinics in KwaZulu Natal were HIV tested. Maternal socio-demographic and health information were recorded, infant outcomes were assessed at clinics and home. Antenatal CD4 counts were determined in HIV-infected women; all infected women and their infants were offered single dose nevirapine.

RESULTS: The median age of 1755 HIV-infected women was 24.8 year and 21.5 year in the 1685 uninfected women. Educational attainment, gestational age at delivery and nutritional status at 6 weeks (MUAC) were equivalent. 10.4% HIV-infected women had CD4 counts < 200 and 29% < 300. There were 11 miscarriages, 51 stillbirths and 3 antenatal deaths in the infected group, versus 2, 31 and 1 in the uninfected women. Mode of delivery was similar in HIV-infected and uninfected women i.e. vaginal delivery (82.9% vs. 84.6%) and C/section (12.2% vs. 12.2%). Episiotomy (22.5% vs. 32.6%), duration of labour (9hrs vs. 9hrs) and home delivery rates (11.9% vs. 11.3%) were no different. 1331 infants were born of 1370 pregnancies in HIV-infected women vs. 1323 infants from 1348 pregnancies in uninfected women. Infants born to HIV-infected women were lighter 3000gms (1100 - 4700) vs. 3100gms (1000-5150) and were more often less than 2500gms (11.6% vs. 7.7%). Early neonatal (1% vs. 1.1%) and neonatal (1.4% vs. 1.1%) mortality rates were similar. Overall HIV transmission rate at 6 weeks was 11.7%.

CONCLUSIONS: Maternal HIV infection is associated with an increased risk of miscarriages, stillbirths but not neonatal mortality. HIV-exposed infants were lighter and more likely of low birth weight. Optimising antenatal care of HIV-infected women including appropriate antiretroviral drugs may reduce early fetal losses and improve birthweight in their offspring.

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Prevention | TuPp0401 | Marie Louise Newell
Epidemiology of vertical transmission

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