Maternal and Obstetric Complications among HIV-infected Women Treated with Highly Active Antiretroviral Treatment at a Regional Hospital in Durban, South Africa

HIV is the leading cause of maternal deaths in resource-poor countries. The use of highly active antiretroviral treatment (HAART) has been shown to almost eliminate vertical transmission and improve maternal health outcomes. Its effect on direct obstetric conditions has not been well documented. Methods: We conducted a retrospective study of women who delivered at a regional hospital from April 1, 2011, to April 30, 2014. We employed a stratified random selection, where the first 50 files recorded in the birth register during each calendar month were chosen, at a ratio of one HIV uninfected for every 4 infected women. Results: We analyzed files belonging to 302 HIV-uninfected women and 1159 HIV-infected women. The latter were further subdivided into those who used zidovudine, n = 424; those who initiated HAART prepregnancy, n = 312; and those who initiated in-pregnancy HAART, n = 423. We found that despite the use of HAART, HIV-infected women were at increased risk of both respiratory and lower genital tract infections (P = 0.009 and 0.001 respectively), compared to HIV-uninfected women. The women receiving HAART before pregnancy had an increased risk of preterm births (P = 0.004), and poor perinatal outcomes (P = 0.002); however, postpartum complications were reduced (P = 0.023). There was a trend toward an increased risk of preeclampsia (P = 0.064). Conclusion: The initiation of HAART before pregnancy reduces the frequency of postpartum complications. However, compared to HIV-negative women, women receiving HAART prepregnancy remained at risk of infectious morbidity, had poor perinatal outcomes, and may also be at an increased risk of preeclampsia.