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Low Birth Weight with Nevirapine-based ART in Abidjan, Côte d’Ivoire: The ANRS Ditrame Plus Cohort and MTCT-Plus Initiative, 2001 to 2007
Didier Koumavi Ekouevi*1,2, B Tonwe-Gold1,3, R Becquet1, P Coffie1,2, P Toure3, V Leroy1, I Viho2, S Blanche4, F Dabis1, and E Abrams5
1INSERM U593, Inst for Publ Hlth, Epi and Devt, Bordeaux, France; 2Natl Agency for AIDS Res Ditrame Plus Project, Abidjan, Côte d`Ivoire; 3ACONDA, NGO, Abidjan, Côte d`Ivoire; 4Hosp Necker, Paris France; and 5MTCT-Plus Initiative, New York, NY, US
Background: Pregnancy
outcomes in women with advanced HIV disease who receive HAART in low-resource settings
are unknown. We investigate this issue within the Ditrame Plus cohort and
subsequent mother-to-child prevention (MTCT) -Plus Initiative in Abidjan.
Methods: All
HIV-infected pregnant women who had had at least 1 delivery and were eligible
for HAART (by World Health Organization [WHO] criteria) were included. From
March 2001 to July 2003, before ART was available, they received a short-course
antiretroviral regimen (scARV) of zidovudine (ZDV) + single-dose of nevirapine
(NVP) or ZDV + lamivudine (3TC) + NVP) (PMTCT group) and from August 2003 to
August 2007, they received a NVP-based ART (AZT/stavudine [d4T] +3TC+NVP) (ART group).
All women in ART group started the 3 ARV ≥28 days
prior to delivery. The following outcomes were studied: low birth weight
(<2500 g), stillbirth, and neonatal mortality. Women with multiple fetuses
were excluded. Factors associated with low birth weight were analyzed using a
logistic regression model.
Results: Of
326 ART-eligible women, 175 received scARV (median CD4, 177 cells/mm3)
and 151 initiated ART (median CD4 count 182 cells/mm3). Stillbirth
rate was 3.3% in the ART group vs 2.9% in the PMTCT group (p = 0.84).
The rate of low birth weight was 22.3% in the ART group and 12.4% in the PMTCT
group (p = 0.02). In a multivariate analysis (n = 309), ART was
independently associated with low birth weight (ORa = 2.53, 95% confidence
interval 1.20 to 5.35; p = 0.015) when adjusting on CD4 count, WHO
staging, maternal age, and maternal body max index. The 1-month probability of
survival in HIV-uninfected children was not statically different in infants
with and without history of low birth weight (94.3% vs 98.8, p = 0.13).
Conclusions:
ART initiated in pregnant women with advanced disease who are eligible for ART
is associated with low birth weight. The
relationship between maternal ART with advanced disease and infant outcomes,
including child survival, requires further study.
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