[Show abstract][Hide abstract] ABSTRACT: Preterm birth (PTB), low birth weight (LBW) and small for gestational age (SGA) contribute to neonatal mortality. Maternal HIV-1 infection has been associated with an increased risk of PTB, but mechanisms underlying this association are undefined. We describe correlates and outcomes of PTB, LBW, and SGA in HIV-exposed uninfected infants.
This was a retrospective analysis of cohort study. Between 1999-2002, pregnant, HIV-infected women were enrolled into an HIV-1 transmission study. Logistic regression was used to identify correlates of PTB, LBW and SGA in HIV-negative, spontaneous singleton deliveries. Associations between birth outcomes and mortality were measured using survival analyses.
In multivariable models, maternal plasma (OR = 2.1, 95%CI = 1.1-3.8) and cervical HIV-1 RNA levels (OR = 1.6, 95%CI = 1.1-2.4), and CD4 < 15% (OR = 2.4, 95%CI = 1.0-5.6) were associated with increased odds of PTB. Abnormal vaginal discharge and cervical polymorphonuclear leukocytes were also associated with PTB. Cervical HIV-1 RNA level (OR = 2.4, 95%CI = 1.5-6.7) was associated with an increased odds of LBW, while increasing parity (OR = 0.46, 95%CI = 0.24-0.88) was associated with reduced odds. Higher maternal body mass index (OR = 0.75, 95%CI = 0.61-0.92) was associated with a reduced odds of SGA, while bacterial vaginosis was associated with >3-fold increased odds (OR = 3.2, 95%CI = 1.4-7.4). PTB, LBW, and SGA were each associated with a >6-fold increased risk of neonatal death, and a >2-fold increased rate of infant mortality within the first year.
Maternal plasma and cervical HIV-1 RNA load, and genital infections may be important risk factors for PTB in HIV-exposed uninfected infants. PTB, LBW, and SGA are associated with increased neonatal and infant mortality in HIV-exposed uninfected infants.
[Show abstract][Hide abstract] ABSTRACT: Michael Gravett and colleagues review the burden of pregnancy-related infections, especially in low- and middle-income countries, and offer suggestions for a more effective intervention strategy.
PLoS Medicine 10/2012; 9(10):e1001324. DOI:10.1371/journal.pmed.1001324 · 14.43 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare genital HSV shedding among HIV-positive and HIV-negative women.
Women with and without known HIV infection who delivered at the University of Washington Medical Center between 1989-1996 had HSV serologies done as part of clinical care. Genital swabs from HSV-2-seropositive women were evaluated by real-time quantitative HSV DNA PCR.
HSV-2 seroprevalence was 71% and 30% among 75 HIV-positive and 3051 HIV-negative women, respectively, (P < .001). HSV was detected at delivery in the genital tract of 30.8% of HIV-seropositive versus 9.5% of HIV-negative women (RR = 3.2, 95% CI 1.6 to 6.5, P = .001). The number of virion copies shed per mL was similar (log 3.54 for HIV positive versus 3.90 for HIV negative, P = .99).
Our study demonstrated that HIV-, HSV-2-coinfected women are more likely to shed HSV at delivery.
Infectious Diseases in Obstetrics and Gynecology 03/2011; 2011:157680. DOI:10.1155/2011/157680