UBC Faculty Research and Publications

Preterm Birth and Antiretroviral Exposure in Infants HIV-Exposed Uninfected Piske, Micah; Qiu, Annie Q.; Maan, Evelyn J.; Sauvé, Laura; Forbes, John C.; Alimenti, Ariane; Janssen, Patricia A.; Money, Deborah M.; Côté, Hélène C. F.


Background: Infants who are HIV-exposed and uninfected (IHEU) born to women living with HIV (WLWH) are at an increased risk of preterm birth (PTB). Antenatal exposure to certain maternal antiretroviral therapy (ART) regimens has been associated with PTB, although existing studies in this domain have been limited with discordant findings. We determined odds of PTB among IHEU by antenatal ART regimens and exposure durations, adjusting for maternal risk factors. Methods: We retrospectively studied IHEU born in British Columbia (BC), Canada between 1990 to 2012 utilizing provincial health administrative databases. Data was collected for infants HIV-unexposed and uninfected (IHUU) controls matched ~3:1 for each IHEU on age, sex and geocode. We determined adjusted odds ratios (AORs) of PTB via multivariable logistic regression. Results: A total of 411 IHEU and 1224 IHUU were included in univariate analysis. PTB was more frequent among IHEU compared to IHUU (20% vs. 7%). IHEU were more often antenatally exposed to alcohol, tobacco, and prescription, non-prescription, and illicit drugs (IHEU: 36%, 8%, 35%; IHUU: 3%, 1%, 9% respectively). After adjusting for maternal substance use and smoking exposure, IHEU remained at increased odds of PTB [AOR:2.66; 1.73, 4.08] compared to matched IHUU controls. ART-exposed IHEU had lower adjusted odds of PTB compared to IHEU with no maternal ART exposure, regardless of regimen (excluding NRTIs only) (AOR: 0.16-0.29[0.02-0.95]) or exposure durations (AOR:0.16-0.25 [0.06-0.78]). Conclusions: BC IHEU were over twice as likely to be born preterm compared to demographically matched controls. While maternal substance use in pregnancy modulated this risk, we found no adverse associations of PTB with antenatal ART regimens or exposure durations.

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