Hepatitis C is an independent risk factor for preterm delivery in HIV positive women: data from a Warsaw cohort
Pregnant women with HIV/HCV coinfection had a 4-fold greater risk of preterm delivery than women with HIV alone according to findings from Poland presented at HIV Glasgow 2018.
The HIV Outpatient Clinic of the Hospital for Infectious Diseases in Warsaw has provided integrated gynaecological and HIV care since 1994. For this study the investigators reviewed all pregnancy outcomes for women attending the clinic 2006 to 2017.
Of 159 pregnancies with known birth outcome and ART status, 11.9% were preterm; 27% of women had chronic HCV infection at the time of pregnancy. About a third (31.5%) of mothers used drugs during pregnancy and 13.8% received methadone therapy.
Most of the women received ART in pregnancy: 52.9% started before conception and 13.8%, 26.1% and 7.3% in the first, second and third trimesters respectively. Seventy-nine per cent had undetectable viral load (<50 copies/mL) at delivery. The majority received a protease inhibitor (89.9%) with TDF + 3TC or FTC (44.6%) or 3TC + AZT (44%).
In the preterm birth group, the median weeks’ gestation at delivery was 36 (IQR 34 to 36) versus 38 weeks (38 to 39) in the term birth group, p<0.001.
In multivariate analysis, adjusted for timing of ART, type of ART, HBsAg positive status, mode of infection, smoking, drug use, CD4, VL, number of pregnancies and maternal age, the only factor associated with increased odds of preterm births was chronic HCV infection: OR 4.31 (95% CI 1.32 to 14.1), p=0.016.
In univariate analysis, there was also an association between dolutegravir and preterm delivery, but, although topical, this finding was based on only three women receiving it in their ART regimen
Nowicka K et al. HCV co-infection is a strong risk factor for pre-term birth among HIV-positive women on cART: data from HIV out-patient clinic in Warsaw. Glasgow HIV Congress 2018, 28–31 October 2018. Poster abstract P005. https://onlinelibrary.wiley.com/toc/17582652/2018/21/S8 (abstract)