Pregnancy outcome among HIV positive women receiving antenatal HAART versus untreated maternal HIV infection.

OBJECTIVE To evaluate adverse pregnancy outcome in HIV infected women who received highly active antiretroviral therapy (HAART) from early pregnancy compared with untreated-maternal HIV infection. STUDY DESIGN A cohort study. PLACE AND DURATION OF STUDY Antenatal clinic, University of Benin Teaching Hospital, Nigeria, from January 2008 to June 2009. METHODOLOGY Two hundred and forty nine HIV infected women who had intrapartum care constituted the study population. Unbooked HIV positive pregnant women, who had not received antiretroviral drugs during the antenatal period but received nevirapine in labour, referred to as untreated-maternal HIV infection, were compared with women who received HAART early in pregnancy. Outcome measures of interest were obstetric complications and perinatal outcome proportion. RESULTS Intrauterine growth restriction (IUGR) (20.5% vs. 6.3%, p = 0.003), pre-term birth (25.0% vs. 9.8%, p = 0.005) and caesarean delivery (45.5% vs. 29.8%, p = 0.04) were significantly higher among women with untreated-HIV infection in pregnancy compared with women who received HAART from early pregnancy. Untreated maternal HIV-infection was associated with higher frequency of birth weight less than 2500g, 5-minutes Apgar score less than 7 and admission into neonatal unit (p < 0.05). Women with primary education were significantly higher in the group with untreated maternal HIV infection (27.3% vs. 12.7%, p = 0.003). CONCLUSION Untreated maternal HIV-infection in pregnancy may be associated with adverse pregnancy outcome. HIV positive women with low level of education utilise PMTCT services suboptimally. This information is important for programmes designed to increase access to PMTCT services including HAART from early pregnancy.