Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa
Abstract Background In South Africa, women continue to face a high burden of Human Immunodeficiency Virus (HIV) infection and the possible complications thereof during pregnancy. We assessed pregnancy incidence rates and outcomes in a longitudinal HIV cohort study over a 15-year period. Methods We e...
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-022-04829-2 |
| _version_ | 1828430757699256320 |
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| author | Nivashnee Naicker Nonhlanhla Yende-Zuma Ayesha B. M. Kharsany Hlengiwe Shozi Duduzile Nkosi Anushka Naidoo Nigel Garrett Salim S. Abdool Karim |
| author_facet | Nivashnee Naicker Nonhlanhla Yende-Zuma Ayesha B. M. Kharsany Hlengiwe Shozi Duduzile Nkosi Anushka Naidoo Nigel Garrett Salim S. Abdool Karim |
| author_sort | Nivashnee Naicker |
| collection | DOAJ |
| description | Abstract Background In South Africa, women continue to face a high burden of Human Immunodeficiency Virus (HIV) infection and the possible complications thereof during pregnancy. We assessed pregnancy incidence rates and outcomes in a longitudinal HIV cohort study over a 15-year period. Methods We evaluated pregnancies among women ≥ 18 years between 2004 and 2019 in the CAPRISA 002 study. We analysed pregnancy rates following HIV acquisition, CD4 counts and HIV viral load dynamics and pregnancy outcomes. We used linear regression to assess if the mean CD4 and log10 viral load close to delivery increases or decreases linearly across three different timepoints. Results In total 245 women enrolled into the HIV negative study phase, 225 into the HIV infection phase and 232 in the antiretroviral therapy (ART) phase. Median follow-up time was 2.0 years [Interquartile Range (IQR) 0.8–2.0] during the HIV negative phase, 2.6 years; (IQR) 1.2–4.8] during HIV infection and 3.7 years (IQR 1.8–5.0) on ART, with maximum follow-up time of 2, 10 and 6 years respectively. Overall, 169 pregnancies occurred in 140 women, of which 16 pregnancies were observed during acute or early HIV infection [Incidence Rate (IR) 8.0 per 100 women-years; 95% confidence interval (CI): 4.6—12.9], 48 during established infection [IR 9.3; (CI 6.8–12.3)] and 68 on ART [IR 8.9; (CI: 7.0 – 11.4)]. Birth outcomes from 155/169 (91.7%) pregnancies were 118 (76.1%) full term live births, 17 (10.9%) premature live births, 9 (5.8%) therapeutic/elective miscarriages, 8 (5.1%) spontaneous miscarriages and 3 (1.9%) spontaneous foetal deaths or stillbirths. Six mother-to-child transmission events occurred, with four documented prior to 2008. Over time, mean CD4 count in pregnant women increased from 395 cells/µL (2004—2009) to 543 cells/µL (2010–2014) and to 696 cells/µL (2015–2019), p < 0.001. Conversely, the viral load declined from 4.2 log10 copies/ml to 2.5 log10 copies/ml and to 1.2 log10 copies/ml (p < 0.001) for the corresponding periods. Conclusions Pregnancy rates following HIV acquisition were high, emphasising a need for timeous ART provision and contraception counselling in women recently diagnosed with HIV. CD4 count and HIV viral load trajectories reflect improvements in treatment guidance for pregnant women over time. |
| first_indexed | 2024-12-10T17:53:22Z |
| format | Article |
| id | doaj.art-555d7702d7304b429b33008ae7299d6c |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-12-10T17:53:22Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-555d7702d7304b429b33008ae7299d6c2022-12-22T01:39:01ZengBMCBMC Pregnancy and Childbirth1471-23932022-07-0122111110.1186/s12884-022-04829-2Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South AfricaNivashnee Naicker0Nonhlanhla Yende-Zuma1Ayesha B. M. Kharsany2Hlengiwe Shozi3Duduzile Nkosi4Anushka Naidoo5Nigel Garrett6Salim S. Abdool Karim7Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalCentre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute (2nd floor), Nelson R Mandela School of Medicine, University of KwaZulu–NatalAbstract Background In South Africa, women continue to face a high burden of Human Immunodeficiency Virus (HIV) infection and the possible complications thereof during pregnancy. We assessed pregnancy incidence rates and outcomes in a longitudinal HIV cohort study over a 15-year period. Methods We evaluated pregnancies among women ≥ 18 years between 2004 and 2019 in the CAPRISA 002 study. We analysed pregnancy rates following HIV acquisition, CD4 counts and HIV viral load dynamics and pregnancy outcomes. We used linear regression to assess if the mean CD4 and log10 viral load close to delivery increases or decreases linearly across three different timepoints. Results In total 245 women enrolled into the HIV negative study phase, 225 into the HIV infection phase and 232 in the antiretroviral therapy (ART) phase. Median follow-up time was 2.0 years [Interquartile Range (IQR) 0.8–2.0] during the HIV negative phase, 2.6 years; (IQR) 1.2–4.8] during HIV infection and 3.7 years (IQR 1.8–5.0) on ART, with maximum follow-up time of 2, 10 and 6 years respectively. Overall, 169 pregnancies occurred in 140 women, of which 16 pregnancies were observed during acute or early HIV infection [Incidence Rate (IR) 8.0 per 100 women-years; 95% confidence interval (CI): 4.6—12.9], 48 during established infection [IR 9.3; (CI 6.8–12.3)] and 68 on ART [IR 8.9; (CI: 7.0 – 11.4)]. Birth outcomes from 155/169 (91.7%) pregnancies were 118 (76.1%) full term live births, 17 (10.9%) premature live births, 9 (5.8%) therapeutic/elective miscarriages, 8 (5.1%) spontaneous miscarriages and 3 (1.9%) spontaneous foetal deaths or stillbirths. Six mother-to-child transmission events occurred, with four documented prior to 2008. Over time, mean CD4 count in pregnant women increased from 395 cells/µL (2004—2009) to 543 cells/µL (2010–2014) and to 696 cells/µL (2015–2019), p < 0.001. Conversely, the viral load declined from 4.2 log10 copies/ml to 2.5 log10 copies/ml and to 1.2 log10 copies/ml (p < 0.001) for the corresponding periods. Conclusions Pregnancy rates following HIV acquisition were high, emphasising a need for timeous ART provision and contraception counselling in women recently diagnosed with HIV. CD4 count and HIV viral load trajectories reflect improvements in treatment guidance for pregnant women over time.https://doi.org/10.1186/s12884-022-04829-2PregnancyHIV infectionAntiretroviral therapy |
| spellingShingle | Nivashnee Naicker Nonhlanhla Yende-Zuma Ayesha B. M. Kharsany Hlengiwe Shozi Duduzile Nkosi Anushka Naidoo Nigel Garrett Salim S. Abdool Karim Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa BMC Pregnancy and Childbirth Pregnancy HIV infection Antiretroviral therapy |
| title | Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa |
| title_full | Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa |
| title_fullStr | Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa |
| title_full_unstemmed | Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa |
| title_short | Pregnancy rates and outcomes in a longitudinal HIV cohort in the context of evolving antiretroviral treatment provision in South Africa |
| title_sort | pregnancy rates and outcomes in a longitudinal hiv cohort in the context of evolving antiretroviral treatment provision in south africa |
| topic | Pregnancy HIV infection Antiretroviral therapy |
| url | https://doi.org/10.1186/s12884-022-04829-2 |
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