Severity of Maternal HIV-1 Disease Is Associated With Adverse Birth Outcomes in Malawian Women: A Cohort Study

Background: 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. Methods: 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. Results: 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-log(10) increase, 95% CI: 1.12 to 1.86) and placental viral load and LBW (PR: 1.24 per 1-log(10) 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-log(10) increase, 95% CI: 1.04 to 1.69). These associations persisted in multivariate models adjusted for residence, maternal education, primigravid status, and maternal anemia. Conclusions: 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 malariainfected women.