Incidence and predictors of adverse pregnancy outcomes with maternal HIV-1 immune reconstitution inflammatory response syndrome among women within reproductive age in selected hospitals, Nairobi, Kenya (A prospective cohort study)

Abstract

Background: With enhanced rollout of anti-retroviral therapy (ART) following prevention of mother to child transmission (PMTCT) and the associated burden of opportunistic infections in developing countries, human immunodeficiency virus-immune reconstitution inflammatory syndrome (HIV-IRIS) may remain a public health area of major concern especially, in pregnancy. Ascertaining the association between maternal HIV infection and adverse maternal and birth related outcomes could be conflicted by the relationship between maternal-HIV- IRIS and the adverse pregnancy-fetal outcomes (APFOs) in HIV-infected mothers. We sought to estimate the incidence and determine possible predictors for adverse pregnancy-fetal outcomes with maternal-HIV-IRIS in ART naïve HIV infected pregnant women. Methodology: Subjects grouped in to IRIS exposed and non-IRIS exposed were followed from the end of first trimester for six and half months. Chi-square test was used to establish the association between the variables at p-value < 0.05. Regression analysis was performed to identify independent predictors of APFOs. Adjusted Relative Risk at 95% confidence interval was determined. Results: The IRIS exposed pregnant women, had a 26.47% adverse pregnancy-fetal outcomes cumulative incidence compared to 10.78% among IRIS non-exposed women. The APFO incidence rate estimate was 0.012 and 0.0045 per person’s week respectively. IRIS cases had 2.46 times the risk of experiencing an APFO compared to those who did not [OR=3; 95%CI: 1.4-6.4; P=.004], at bivariate analysis, not sustained at the multivariate analysis [AOR=1.6; 95%CI: 0.4-5.8; P = .508]. Multiple logistic regression dropped maternal HIV-IRIS and revealed; HIV-RNA viral load at baseline of above 50 copies/ml [AOR=2.7; 95%CI: 1.2-6.3; P=.017], Maternal placental syndrome(MPS) characterized by hypertensive event [AOR=0.1; 95%CI:0.0-1.0; P = .052] and mother’s general health during delivery [AOR= 4; 95%CI: 4.0:1.8-9.1;P=.001] as independent predictors of APFOs. Conclusion: There is a higher incidence of APFOs among maternal HIV-IRIS diagnosed pregnant women as compared to non-HIV maternal IRIS diagnosed pregnant women. In particular, MPS characterized by an hypertensive event, HIV-RNA viral load at baseline of above 50 copies/ml and mother’s general health during delivery are key predictors of an adverse pregnancy outcome. Interventions to reduce the associated risk predictors identified in this analysis should be studied for their effects on reducing APFOs.