Timing is everything: assessing the impact of maternal HIV infection diagnosis timing on infant outcomes in a ten-year retrospective cohort study in South Carolina

ABSTRACT

The aims were to evaluate the impact of maternal HIV infection diagnosis timing on infant outcomes. The outcomes of interest included preterm delivery (PTD) and confirmed infant HIV infection. Data for all HIV-exposed infants from 2004–14 were obtained. Maternal HIV infection diagnosis timing was categorized as: perinatal (PHIV), adult infection before conception, and after conception. Infant outcomes were compared according to timing of maternal HIV diagnosis. Bivariate outcomes were compared using χ² tests. Continuous variables were compared using Kruskal-Wallis tests. Logistic regression was used to determine predictors of PTD and infant HIV infection. Most women were diagnosed with HIV before conception: PHIV (21, 3%), before conception (431, 69%), and post-conception (176, 28%). Women diagnosed with HIV as an adult before conception were more likely to deliver preterm (P = 0.007). Prenatal care was associated with lower risk of PTD (aOR 0.1, 95% CI 0.04–0.5). Six infants contracted HIV. Infant HIV infection was more likely in women who did not take antiretroviral therapy (aOR 13.5, 95% CI 2.5–72.1) or delivered preterm (aOR 5.3, 95% 1.1–25.1). Women with PHIV were more likely to deliver at term, and there were no HIV infections among PHIV-exposed infants. These findings are reassuring to PHIV women who desire pregnancy.

KEYWORDS:

• HIV
• pregnancy
• perinatal
• preterm birth
• low birth weight
• small for gestational age

Acknowledgements

We wish to extend special thanks to the SCDHEC members Terri G Stephens, Emma Kennedy, Latoya Jackson and Kirk Shull.

Disclosure statement

Dr. Lazenby is a member of the DHHS HIV Perinatal guidelines committee and American College of Obstetrics and Gynecology GYN Practice Committee. Other authors do not have any conflicts of interest to disclose.

Additional information

Funding

This publication was supported, in part, by the National Center for Advancing Translational Sciences of the National Institutes of Health [grant number UL1 TR001450]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.