Study of birth outcome in pregnant HIV-positive women in a tertiary care hospital

ABSTRACT Background: Human immunodeficiency virus (HIV) remains a global epidemic, with adolescents and young people increasingly affected. In India, adult HIV cases have declined since 2000, with an estimated 2.4 million people living with HIV as of 2021. Methodology: This retrospective observational study aimed to compare pregnancy outcomes based on maternal antiretroviral therapy (ART) regimens among 45 HIV-positive mothers at JSS Medical College, Mysuru, from December 2012 to March 2023. Participants were categorized by ART regimens: old regimen (Tenofovir + Lamivudine + Efavirenz, TLE) and new regimen (Tenofovir + Lamivudine + Dolutegravir, TLD). Outcomes included preterm birth, low birth weight, adverse outcomes, and infant HIV status. Results: Preterm delivery and very low birth weight were reported with the TLE regimen, while HIV-positive status was seen only with the TLD regimen. The odds of low birth weight were higher with the TLD regimen (OR: 1.167) compared to TLE (OR: 0.750), though not statistically significant. Adverse outcomes were more frequent with TLE (OR: 1.063) than with TLD (OR: 0.958). The study also found two HIV-positive infants born to mothers on the TLD regimen who initiated ART during the first trimester, highlighting the need for careful regimen selection and timing. Conclusion: The study underscores the importance of early ART initiation to reduce vertical transmission and improve maternal CD4 counts, with continuous monitoring recommended to minimize adverse outcomes. Further large-scale prospective studies are necessary to understand better the impact of different ART regimens on pregnancy outcomes.