Original Research

No increased in utero and peripartum HIV acquisition risk in HIV-exposed preterm infants

Gbolahan Ajibola, Charlotte Mdluli, Kara Bennett, Maureen Sakoi, Oganne Batlang, Joseph Makhema, Shahin Lockman, Roger Shapiro, Landon Myer, Kathleen Powis
Southern African Journal of HIV Medicine | Vol 24, No 1 | a1509 | DOI: https://doi.org/10.4102/sajhivmed.v24i1.1509 | © 2023 Gbolahan Ajibola, Charlotte Mdluli, Kara Bennett, Maureen Sakoi, Oganne Batlang, Joseph Makhema, Shahin Lockman, Roger Shapiro, Landon Myer, Kathleen Powis | This work is licensed under CC Attribution 4.0
Submitted: 04 June 2023 | Published: 19 October 2023

About the author(s)

Gbolahan Ajibola, Botswana Harvard AIDS Research Institute, Gaborone, Botswana
Charlotte Mdluli, Botswana Harvard AIDS Research Institute, Gaborone, Botswana
Kara Bennett, Bennett Statistical Consulting Inc, New York, United States
Maureen Sakoi, Botswana Harvard AIDS Research Institute, Gaborone, Botswana
Oganne Batlang, Botswana Harvard AIDS Research Institute, Gaborone, Botswana
Joseph Makhema, Botswana Harvard AIDS Research Institute, Gaborone, Botswana
Shahin Lockman, Botswana Harvard AIDS Research Institute, Gaborone, Botswana; and, Department of Infectious Diseases, Brigham and Womens Hospital, Boston, United States of America; and, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States
Roger Shapiro, Botswana Harvard AIDS Research Institute, Gaborone, Botswana; and, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States
Landon Myer, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Kathleen Powis, Botswana Harvard AIDS Research Institute, Gaborone, Botswana; and, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, United States of America; and, Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, United States

Abstract

Background: Limited data exist on the differential risk of HIV acquisition between infants born preterm versus those born at term to women living with HIV (WLHIV). With a reported increase in preterm delivery among pregnant WLHIV, understanding the risk of vertical transmission of HIV in preterm infants can inform strategies to optimise the timing of diagnostic testing, antiretroviral prophylaxis, and infant feeding.

Objectives: To describe the prevalence and timing of HIV acquisition, in utero versus perinatal, among infants with perinatal HIV exposure born prior to 37 weeks completed gestation age compared to those born at term in the Botswana-based Mpepu study and explore predictors of infant HIV acquisition.

Method: Using data extracted from the Mpepu study, we describe the prevalence, timing and risk factors for HIV acquisition in infants born preterm versus those born at term. Fisher exact testing was used to test for differences in prevalence and timing of HIV and a multivariable logistic regression model was used to assess risk factors for infant HIV acquisition.

Results: 2866 infants born to WLHIV were included in this secondary analysis. 532 (19%) were born preterm. There was no observed difference in the prevalence of HIV acquisition among infants born preterm versus at term overall (0.8% vs 0.6%, P = 0.54), at birth (0.2% vs 0.3%, P = 1.00) or between 14 and 34 days post-delivery (0.6% vs 0.3%, P = 0.41). The absence of maternal antiretroviral use during pregnancy significantly predicted infant HIV acquisition, with the risk of HIV acquisition reduced by 96% among infants whose mothers were taking antiretroviral treatment (ART) during pregnancy (adjusted odds ratio: 0.003, confidence interval: 0.01–0.02, P < 0.001).

Conclusion: There was no observed increase of in utero and peripartum HIV acquisition among infants born preterm following foetal exposure to HIV compared to those born at term.


Keywords

HIV acquisition risk; preterm neonates; vertical transmission; women living with HIV; antiretroviral treatment

Sustainable Development Goal

Goal 3: Good health and well-being

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