Associations between HIV, antiretroviral therapy and preterm birth in the US Women’s Interagency HIV Study, 1995–2018: a prospective cohort
Year: 2021
Type: article
Study design: Observational Study
Abstract: OBJECTIVE: To evaluate the associations of HIV infection with preterm birth (PTB), and of HIV antiretroviral therapy (ART) with PTB. METHODS: We analysed singleton live-born pregnancies among women from 1995 to 2019 in the Women's Interagency HIV Study, a prospective cohort of US women with, or at risk for, HIV. The primary exposures were HIV status and ART use before delivery [none, monotherapy or dual therapy, or highly active antiretroviral therapy (HAART)]. The primary outcome was PTB < 34 weeks, and, secondarily, < 28 and < 37 weeks. We analysed self-reported birth data, and separately modelled the associations between HIV and PTB, and between ART and PTB, among women with HIV. We used modified Poisson regression, and adjusted for age, race, parity, tobacco use and delivery year, and, when modelling the impact of ART, duration from HIV diagnosis to delivery, nadir CD4 count, and pre-pregnancy viral load and CD4 count. RESULTS: We analysed 488 singleton deliveries (56% exposed to HIV) to 383 women. The risk of PTB < 34 weeks was similar among women with and without HIV, but the risk of PTB < 37 weeks was higher [32% vs. 23%; adjusted risk ratio (aRR) = 1.43; 95% confidence interval (CI): 1.07-1.91] among women with HIV. The risk of PTB < 34 weeks was lower among women with HIV receiving HAART than among those receiving no ART (7% vs. 26%; aRR:0.19; 95% CI: 0.08-0.44). The associations between HAART and PTB < 28 and < 37 weeks were similar. CONCLUSIONS: Antiretroviral therapy exposure was associated with a decreased risk of PTB among a US cohort of women with HIV. Given the growing concerns about ART and adverse pregnancy outcomes, this finding that ART may be protective for PTB is reassuring.
Source: HIV Medicine
DOI: 10.1111/hiv.13171
Institutions: The Ohio State University, University of North Carolina at Chapel Hill, University of Alabama at Birmingham, UAB Medicine, University of Miami, Emory University, Northwestern University, Northwestern Medicine, University of California, San Francisco, Georgetown University, Maimonides Medical Center, SUNY Downstate Health Sciences University, Albert Einstein College of Medicine
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Gilead Sciences, Ohio State University, Northwestern University, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Mental Health, National Institute on Drug Abuse, National Cancer Institute, National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute of Neurological Disorders and Stroke, National Institute of Dental and Craniofacial Research, National Center for Advancing Translational Sciences, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G1329112180, G1400602301, G1655989834, G183157880, G192128497, G2127051194, G248584506, G2755707676, G2759654445, G30074556, G319781266, G3242306066, G343705321, G3481933404, Brooklyn Women's Interagency HIV Study (WIHS) V, G3724623777, G483408255, G5147848267, G5431849782, G5660189159, G5747858550, G5863844756, G6396423216, University of Miami Developmental HIV/AIDS Mental Health Research Center (D-ARC), G693265041, University of North Carolina Womens Interagency HIV Study UNC WIHS, G7152846654, Johns Hopkins Institute for Clinical and Translational Research, G9000010044, G9000025681, G9000037749, G9000050451, G9000066220, G9000088144, G9000093720, G9000126231, G9000132212, UNC MACS/WIHS Combined Cohort Study Clinical Research Site, Surviving the HIV Epidemic (S/HE) in metropolitan Washington DC - Advancing knowledge through cohort studies, Center for AIDS Research at Emory University, The University of North Carolina Center for AIDS Research, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS) - Baltimore/Wash DC Center, UCLA Clinical and Translational Science Institute, Clinical Research Sites for the MACS/WIHS Combined Cohort Study (MACS/WIHS-CCS), UAB Center for AIDS Research (CFAR)
OpenAlex ID: W3199744477