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Low birth weight is associated with maternal nevirapine based antiretroviral therapy in Abidjan, Côte d'Ivoire: the Ditrame Plus project and MTCT-Plus initiative (2001-2007)

Background

Pregnancy outcomes in women on antiretroviral treatment (ART) in low resource-settings are unknown. We investigate this issue within the Ditrame Plus project and MTCT-Plus Initiative in Abidjan.

Methods

All HIV-infected pregnant women with at least one delivery and eligible for ART were included. Between March 2001 and July 2003 when ART was not available, they received a short-course antiretroviral regimen (zidovudine (ZDV) + single-dose of nevirapine (sdNVP) or ZDV + lamivudine + sdNVP) (PMTCT Group) and between August 2003 and August 2007, they received a NVP-based ART therapy (ART Group). The following outcomes were studied: low-birth weight (LBW) (<2500 g), stillbirth and neonatal mortality. Women with multiple pregnancies were excluded. Factors associated with LBW were analysed using a logistic regression model.

Results

Overall, 326 HIV-1 infected women were included: 175 in the PMTCT Group with a median CD4 count 177 cells/mm3 and 151 initiated ART for at least 28 days before delivery with median CD4 count 182 cells/mm3. Still birth rate was 3.3% in the ART vs 2.9% in the PMTCT group, (p=0.84). The rate of LBW was 22.3% in the ART and 12.4% in the PMTCT group (p=0.02). The multivariate regression model (n=309), ART was associated with LBW when adjusting on the CD4 count, WHO staging, maternal age and maternal body max index (ORa=2.53, p=0.015). The survival at 12 month in HIV-uninfected children was similar between the two groups (Log-Rank test, p=0.78). Neither LBW (ORa=1.5, p=0.38) nor the exposition to ART (ORa=1.1, p=0.85) were associated with infant mortality.

Conclusions

ART initiated in pregnant women induced low birth weight compared to newborn exposed to PMTCT regimen despite a supplementation with multivitamin in all pregnant women. The proper effect of maternal HAART on child survival needs to be assessed.

Author information

Correspondence to Patrick Coffie.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Keywords

  • Pregnant Woman
  • Lamivudine
  • Zidovudine
  • Nevirapine
  • Neonatal Mortality