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J Acquir Immune Defic Syndr. 2013 Dec 1;64(4):392-9. doi: 10.1097/QAI.0b013e3182a2d13c.

Severity of maternal HIV-1 disease is associated with adverse birth outcomes in Malawian women: a cohort study.

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*Division of Infectious Diseases, Department of Medicine, Center for Microbial Interface Biology, and Public Health Preparedness for Infectious Diseases Program, Ohio State University, Columbus, OH; †Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH; ‡Department of Obstetrics and Gynecology, College of Medicine, Ohio State University, Columbus, OH; §Department of Community Health, Malawi College of Medicine, Blantyre, Malawi; ‖Department of Medicine, University of Melbourne, Parkville, Victoria, Australia; ¶Department of Epidemiology, University of North Carolina, Chapel Hill, NC; and #Departments of Microbial Infection and Immunity and Microbiology, and Center for Retrovirus Research, Ohio State University, Columbus, OH.



Compared with HIV-negative women, HIV-infected women have increased risk of low birthweight (LBW) and preterm delivery (PTD). We assessed whether severity of maternal HIV-1 disease was associated with LBW or PTD.


Secondary analysis of The Malaria and HIV in Pregnancy prospective cohort, which enrolled HIV-positive, pregnant Malawian women from 2000 to 2004. Included participants (n = 809) were normotensive antiretroviral treatment-naive women who delivered a live singleton infant. Binomial regression models were used to assess the unadjusted and adjusted prevalence ratios (PRs) and 95% confidence intervals (CI) of the effect of severity of HIV-1 disease, defined by viral load and CD4 T-cell counts, on prevalence of LBW and PTD.


In unadjusted analyses, among those with malaria (n = 198), there was no association between severity of HIV-1 infection and LBW, whereas among women without malaria (n = 611), we observed a harmful association between both increasing peripheral viral load and LBW (PR: 1.44 per 1-log10 increase, 95% CI: 1.12 to 1.86) and placental viral load and LBW (PR: 1.24 per 1-log10 increase, 95% CI: 1.00 to 1.53). We observed a similar association between increasing placental viral load and PTD (PR: 1.33 per one-log10 increase, 95% CI: 1.04 to 1.69). These associations persisted in multivariate models adjusted for residence, maternal education, primigravid status, and maternal anemia.


In malaria-negative women, maternal HIV-1 disease severity was significantly associated with increased prevalence of LBW and PTD. Such an association was not found in the malaria-infected women.

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