Autor/a:
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González, Raquel; Rupérez, María; Sevene, Esperança Júlia Pires; Vala, Anifa; Maculuve, Sónia Amós; Bulo, Helder; Nhacolo, Arsénio; Mayor Aparicio, Alfredo Gabriel; Aponte, John J.; Macete, Eusébio; Menéndez, Clara
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Abstract:
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INTRODUCTION: The HIV epidemic is concentrated in sub-Saharan
Africa. However, limited information exists on its impact on
women and infant's health since the introduction of
antiretroviral drugs in this region, where health resources are
often scarce. METHODS: The effect of HIV infection on maternal
health, birth outcomes and infant health was analysed in two
contemporary cohorts of HIV-uninfected and HIV-infected pregnant
women from southern Mozambique. Pregnant women attending the
first antenatal care visit were followed until one month after
delivery. Antiretroviral therapy was administered based on CD4+T
cell count and clinical stage. Maternal and neonatal morbidity
and mortality, as well as pregnancy outcomes were assessed by
mother's HIV status. RESULTS: A total of 1183 HIV-uninfected and
561 HIV-infected pregnant women were enrolled. HIV-infected
women were more likely to have anaemia both at the first
antenatal care visit and at delivery than HIV-uninfected women
(71.5% versus 54.8% and 49.4% versus 40.6%, respectively,
p<0.001). Incidence of hospital admissions during pregnancy
was increased among HIV-infected women (RR, 2.04, [95%CI, 1.45;
2.86]; p<0.001). At delivery, 21% of HIV-infected women
reported being on antiretroviral therapy, and 70% having
received antiretroviral drugs for prevention of mother to child
transmission of HIV. The risk of stillbirths was doubled in
HIV-infected women (RR, 2.16 [95%CI 1.17; 3.96], p = 0.013).
Foetal anaemia was also increased among infants born to
HIV-infected women (10.6% versus 7.3%, p = 0.022). No
differences were found in mean birth weight, malaria,
prematurity and maternal and neonatal deaths between groups.
CONCLUSIONS: HIV infection continues to be associated with
significant maternal morbidity and poor neonatal health
outcomes. Efforts should urgently be made to identify the
barriers that impede improvements on the devastating effects of
HIV in African women and their infants. TRIAL REGISTRATION:
ClinicalTrials.gov NCT 00811421. |