OBSTETRIC AND NEONATAL OUTCOME IN PREGNANT HIV-POSITIVE WOMEN RECEIVING HAART IN AMINU KANO TEACHING HOSPITAL

Abstract

BACKGROUND
Human immunodeficiency virus (HIV) infection constitute serious health problem
especially in sub-Saharan Africa and other developing countries of the world. In
developing countries where over 70-80% of the affected women reside and
comprehensive health care is limited, vertical transmission of the virus as well as
other adverse obstetrics and neonatal outcomes are still very common. With the use
of HAART in pregnancy, it is expected that the outcome of pregnancy will
improve. However, it still remains controversial if some of these observed adverse
outcomes are as a result of use HAART or from HIV infection.
AIM AND OBJECTIVES
To determine the differences in the sociodemographic characteristics as well as
obstetric and neonatal outcome in HIV-positive pregnant women on HAART and
HIV- negative pregnant women attending ANC at AKTH.
METHODOLOGY
This is a prospective case control study conducted in AKTH between February
2014 and October 2014.The cases consist of HIV-positive pregnant women who
tested positive during the booking clinic, those referred to PMTCT services and
those already on HAART for their disease and subsequently delivered in the
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hospital that met the inclusion criteria. The control consist of the next appropriately
matched HIV-negative pregnant women presenting for booking clinic and
subsequently delivered in the hospital and also met the inclusion criteria .
Questionnaires were used to collect data on the sociodemographic, biological
characteristic and past obstetric history of the women in the study. Descriptive
analysis of the result was done using the statistical package for social sciences
version 15(SPSS15, Chicago, IL, USA), P<0.05 was considered significant,
providing 95% confidence interval.
RESULT
Out of the 110 pregnant women that tested positive for HIV, 18(16.4%) were
newly diagnosed i.e. started ART post conception and 92(83.6%) were receiving
ART pre conception for their disease. None of the participants booked for ANC in
the first trimester. Anaemia, PROM and PTB were found to be significantly higher
in HIV-positive pregnant women than the control p=0.002, 0.004, 0.0001
respectively. Birth weight of <2500g,5min apgar score of less than 7 and
admission into SCBU were significantly higher in HIV-positive pregnant women
on HAART compared with their HIV-negative counterpart p=0.001,0.03 and0.01
respectively. Out of the 93 neonates who had HIV test six weeks postpartum, 2
were found to be HIV-positive by PCR giving a perinatal transmission rate of
2.2%. Adverse obstetric and neonatal outcomes were observed in 38.2% of HIV
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positive pregnant women compared to the control(11.8%),of which low level of
education, late gestational age at booking,CD4cell count <350cells/ml and viral
load of >1000 copies/ml were significantly associated with adverse outcome.
CONCLUSION
Despite HAART, pregnancies complicated by HIV infection carry high adverse
obstetrics and neonatal outcome. This study shows that HIV-positive pregnant
women on HAART are significantly more likely to have anemia in pregnancy,
PROM, preterm birth and low birth weight. This information shows that even with
HAART, pregnancies complicated by HIV infection should be considered high risk
and those caring for them should watch out for these complications.

OBSTETRIC AND NEONATAL OUTCOME IN PREGNANT HIV-POSITIVE WOMEN RECEIVING HAART IN AMINU KANO TEACHING HOSPITAL