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Pregnancy Outcome of ART-experienced and ART-naïve HIV-infected Mothers at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Untreated maternal Human Immunodeficiency Virus (HIV) infection is associated with adverse pregnancy outcome including preterm birth, low birth weight, and mother-to-child transmission of the virus. This study aimed to compare the pregnancy outcome between HIV infected mothers who received ART in pregnancy and those who were ART-naïve. 
Methods: A cross-sectional study of HIV-infected mothers who brought their infants for follow up between November 2007 and May 2017 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Relevant information obtained include: time of diagnosis, antiretroviral therapy (ART) regimen and when it was commenced, gestational age at delivery and birthweight of child, mode of delivery, infant feeding option and ARV prophylaxis. Infection status of the infant was determined by DNA PCR at 6weeks of age. Based on when ART was commenced, mothers were grouped into three [(HAART experienced (HE) if ART was started before pregnancy, HAART in pregnancy (HIP) and HAART naive (NH) if no HAART was taken in pregnancy]. Main outcome measures were rates of prematurity, low birth weight, mean birth weight, birth defects and mother-to-child transmission. 
Result: A total of 1,640 HIV-exposed infants were seen (716(43.6%) in HE, 360(22.0%) in HIP and 564(34.4%) in NH groups). There were 825(50.3%) males and 815(49.7%) females. Zidovudine/Lamivudine and Nevirapine/Efavirenz was the most frequently used combined ART in 724 (67.3%) mothers. The mean birthweight was 3.12±0.38Kg; range 1.2 – 5.7Kg (3.11±0.58Kg in HE; 3.13±0.53Kg in HIP; 3.18±0.74Kg in NH) Table 3. A hundred and eighty (11.0%) babies were preterm [76(42.2%) in HE; 26(14.4%) in HIP; 78(43.3%) in NH](p=0.007), while 159(9.7%) were LBW [74(46.5%) in HE; 22(13.8%) in HIP; 63(39.6%) in NH](p=0.03). Fourteen (0.9%) babies had birth defects [5(35.7%) in HE; 9(64.3%) in HIP] (p=0.01). The commonest birth defects were neural tube defect 7(50%) and congenital heart defect 4(28.8%). Overall transmission rate was 21.4% [8% in the HE, 4.5% in HIP and 87.5% in NH groups] (p=0.001). The mean birth weights of uninfected babies were higher than their infected counterparts but was not significant (p>0.05). 
Conclusion: The benefits of early HAART in reducing mother-to-child transmission must be weighed against the risks of lower birthweight and potential teratogenic effects of drug exposure on the foetus.