BACKGROUND. Despite the recognized benefit of antiretroviral therapy (ART) for preventing and treating HIV, some studies have
reported adverse birth outcomes with in utero ART exposure. We evaluated the effect of infant in utero HIV and ART exposure on
preterm delivery (PTD), low birth weight (LBW), small for gestational age (SGA), and underweight for age (UFA) at 6 weeks.
METHODS. We surveyed 6179 HIV-unexposed-uninfected (HUU) and 2599 HIV-exposed-uninfected (HEU) infants. HEU infants
were stratified into 3 groups: ART, Zidovudine alone, and no antiretrovirals (None). The ART group was further stratified to explore
pre- or postconception exposure. Multivariable logistic regression evaluated effects of HIV and ARV exposure on the outcomes.
RESULTS. We found higher odds of PTD, LBW, SGA, and UFA in HEU than HUU infants. HEU in the None group (adjusted
odds ratio [AOR], 1.9; 95% confidence interval [CI], 1.2–3.0) or those whose mothers initiated ART preconception (AOR, 1.7; 95%
CI, 1.1–2.5) had almost twice the odds of PTD than infants whose mothers started ART postconception, but no increased odds for
CONCLUSIONS. There was an association between preconception ART and PTD. As ART access increases, pregnancy registers or
similar surveillance should be in place to monitor outcomes to inform future policy.
We would like to thank the mothers/caregivers and infants who participated
in the 2012–13 South African PMTCT Evaluation survey.
The work was presented in part at the 6th
African Nutritional Epidemiology Conference; July, 21–25, 2014; Accra,
Ghana and the 9th International AIDS Conference on HIV Science; July,
23–26, 2017; Paris, France.