Pregnancy Outcomes and All-Cause Mortality After Pregnancy Among US-Born Women With Perinatally Acquired HIV.

Abstract

Background: Maternal and pregnancy outcomes among women with perinatally acquired HIV (PHIV) versus women with HIV acquired through other routes (NPHIV) are not fully understood.

Setting: US-born women during 2005-2015 in New York City.

Methods: We used data from the New York City HIV surveillance registry, Expanded Perinatal Surveillance database, and Vital Statistics, to compare pregnancy and all-cause mortality outcomes among women with PHIV versus NPHIV delivering infants during 2005-2015.

Results: There were 186 deliveries among 137 women with PHIV and 1188 deliveries among 910 women with NPHIV. Women with PHIV were younger at delivery, more likely to be aware of their HIV status, and less likely to use substances or be incarcerated. At the time of delivery, women with PHIV were more likely to have HIV RNA >1000 copies/mL (34% vs. 19%), CD4 <200 cells/µL (18% vs. 7%; median CD4 300 cells/µL vs. 435 cells/µL), to have adequate prenatal care (43% vs. 35%), and to deliver by elective C-section (63% vs. 49%). There were no differences in intrapartum and neonatal antiretroviral therapy use, perinatal transmission, gestational age, and birth weight of the infants, nor infant mortality. Women with NPHIV had higher survival than women with PHIV (RR = 2.29, P = 0.004; age-adjusted risk ratio = 3.23, P < 0.001; age and CD4 adjusted risk ratio = 2.09, P = 0.046).

Conclusions: Women with PHIV had lower long-term survival after delivery likely because of limited HIV treatment options in childhood and a longer duration of HIV infection, underscoring the importance of close follow-up and tailored support services beyond the postpartum period.