Effects of HIV Infection on Pregnancy Outcomes Among Women Attending Antenatal Care in Referral Hospitals of the Amhara Regional State, Ethiopia: A Prospective Cohort Study

Abstract

Background Human immunodeficiency virus (HIV) has remained to be a significant public health problem worldwide mainly affecting women. Despite a 2 to 3 times higher risk of adverse pregnancy outcomes, around 2 million HIV positive women give birth each year globally. However, there is a dearth of evidences in Ethiopia about the effect of maternal HIV infection on pregnancy outcomes where adverse birth outcomes are still a significant health problem. This study is, therefore, aimed to examine the effect of HIV on the risk of adverse pregnancy outcomes in Amhara Regional State, Ethiopia. Methods A prospective cohort study was conducted among 704 pregnant women (352 women with HIV and 352 women without HIV infection). Systematic random sampling technique was employed to select the study participants. Data on socio-demographic, obstetric, clinical, as well as behavioral and psychosocial characteristics were collected using a validated tool. Data on the outcome variables were also collected following delivery. Modified Poisson regression was employed to estimate the relative risk (RR) of HIV on low birth weight (LBW), preterm birth, and still birth at 95% confidence level. Attributable fraction (AF) was used to report the impact of HIV infection on pregnancy outcomes. Results Of the total 704 pregnant women enrolled for the study, 96.3% (678) completed the study. The mean age of the study participants was 30.8 (SD ± 5.4) for HIV positive and 27 (SD ± 5.4) for HIV negative women. The cumulative incidence of low birth weight, preterm birth, and stillbirth were 21.4%, 9.4%, and 4.1%, respectively. The incidence of LBW was 24.7% among HIV positive and 17.8% among HIV negative women. The incidence of preterm birth was 10.7% among HIV positive and 7.9% among HIV negative women. And the incidence of stillbirth was 3.7% and 4.6% among HIV positive and those HIV negative women. New-borns from women with HIV infection had a higher risk of low birth weight and preterm birth than those HIV negative women (Adjusted Relative Risk (ARR) = 1.47; 95% CI: 1.06–2.03) and (ARR = 1.74; 95% CI: 1.08–2.79), respectively. The attributable risk of HIV on low birth weight was 32% (Attributable Fraction (AF) = 32%, 95% CI: 23–46%), and 43% (AF = 43%, 95% CI: 23–46%) for preterm birth. Conclusion Maternal HIV infection increased the risk of low birth weight and preterm birth. This implies due attention is required while providing maternal health services primarily antenatal care and delivery services. These services should be aimed at reducing adverse pregnancy outcomes with more attention given to women with HIV infection. Moreover, reinforcement of HIV prevention intervention strategies should be considered at all levels.

Gestational weight gain and adverse birth outcomes in South African women with HIV on antiretroviral therapy and without HIV: a prospective cohort study

“…On the other hand, almost half of our cohort had GWG above the NAM recommended range, including one‐third of WHIV. These results are concerning considering that PHIV already have a higher risk of adverse birth outcomes [ 37 , 38 ] and metabolic health outcomes associated with HIV‐induced chronic inflammation [ 39 – 41 ]. In addition, unwanted GWG in PHIV could exacerbate their poor mental health and negatively affect ART adherence [ 42 ].…”

The Effect of Human Immunodeficiency Virus (Hiv) and Antiretroviral Therapy on the Risk of Pre-Eclampsia : A Ten Years Systematic Review

“…5 Two impacts of HIV infection on the fetus include higher risk of unfavorable pregnancy outcomes and vertical transmission, both of which have a major effect on the survival of the newborn. 6 Regardless of CD4+ cell count, the World Health Organization (WHO) and UNICEF recommended in 2013 that all pregnant HIV-positive women start antiretroviral therapy (ART) early in their pregnancy and continue it for the rest of their lives. 7 The link between exposure to ART during pregnancy and unfavorable pregnancy outcomes, such as low birth weight and/or premature birth, has come to light more recently as vertical transmission rates continue to drop globally.…”

“…7 The link between exposure to ART during pregnancy and unfavorable pregnancy outcomes, such as low birth weight and/or premature birth, has come to light more recently as vertical transmission rates continue to drop globally. 6,7 According to a number of research conducted in recent years, infection-related inflammation may have a significant impact on the development of pre-eclampsia. On the other hand, preexisting data refute the notion that HIV infection contributes to the development of pre-eclampsia.…”

Trends Analysis of HIV Infection and Antiretroviral Treatment Outcome in Amhara Regional from 2015 to 2021, Northeast Ethiopia

“…In Ethiopia, 48,0000 HIV-positive people will have received antiretroviral therapy by 2020. 14,15 In response to this epidemic, WHO declared three 90-90-90 fast-track targets to accomplish the Sustainable Development Goals (SDG) to end the epidemic of AIDS by 2030 within the context of confirming healthy lives and promoting well-being for all at all ages. 16 In 2021, UNAIDS updated its fast-track targets to three: 95% of people living with HIV will know their HIV status; 95% of people who know their HIV status will receive antiretroviral therapy (ART), and 95% of those who receive ART will have viral suppression.…”