Studio osservazionale caso-controllo sugli outcome neonatali in donne gravide con infezione da HIV: Genova San Martino 2015-2018

Antiretroviral therapy (ART) in pregnancy was associated with a drastic reduction in HIV mother-to-child transmission (MTCT), but the risk of preterm birth (PTB) and low birth weight (LBW) remained high in HIV-infected pregnant women. The objective of the study was to evaluate neonatal outcomes (PTB, LBW and small for gestational age infants (SGA)) and hematological and hepatic adverse events in HIV-infected pregnant women and to compare these outcomes with those of infants born to HIV-uninfected women. Neonatal outcomes were analyzed in two contemporary cohorts of HIV-infected and HIV-uninfected pregnant women attending to San Martino Hospital in Genoa between 2015 and 2018. Multivariate logistic regression will be used to estimate the adjusted effect of HIV status on neonatal outcomes. Overall, 16 infants born to HIV-infected women and 80 infants born to HIV-uninfected women were included in the study. No differences statistically significant in demographic and clinical characteristics were found in two cohorts of women (median age was 31.6 years in HIV-infected group vs. 33.2 years in HIV-uninfected group of women), except for foreign women who were 85.7% in HIV-infected group and 17.5% in HIV-uninfected group (p<0.001). The diagnosis of HIV infection was performed before pregnancy in the majority of cases (72%). Nine (65%) patients were on ART at conception and almost all (86%) had been treated during pregnancy. Observed neonatal outcomes in infants born to HIV-infected women were: 31.3% PTB (vs. 10% in infants born to HIV-uninfected women, p=0.04), 31.3% LBW (vs. 6.3% in infants born to HIV-uninfected women, p=0.03), 18.8% SGA (vs. 11.3% in infants born to HIV-uninfected women, p=0.41). In the multivariate analysis, mother’s HIV infection was associated with LBW (OR=5.8; CI95%, 1.3-24.7; p=0.02). Biochemical adverse effects in infants born to HIV-infected women were: liver function test abnormalities (53%), anemia (31%) and thrombocytopenia (6%). In conclusion, rates of PTB and LBW were higher among infants born to HIV-infected women than in those born to HIV-uninfected women. Mother’s HIV infection was associated with an increased risk of LBW, but not with PTB.