Highly Active Antiretroviral Therapy and adverse pregnancy outcome in Ouagadougou, Burkina Faso.

Objective: The administration of highly active antiretroviral therapy (HAART) to HIV-infected pregnant women raised the question of the association with adverse pregnancy outcomes. There is limited information regarding use of HAART during pregnancy in resource-constrained settings, where an increasing number of women need HAART administration. Our aim was to explore the association between HAART administration and adverse pregnancy outcomes and low birth weight (LBW)in a resource-limited setting. Methods: A retrospective cohort of HIV-infected pregnant women enrolled in the programme of Prevention of Mother-to- Child Transmission between 2003 and 2007 in Ouagadougou, Burkina Faso, was considered. Age, CD4+ T lymphocyte count, type and timing of antiretroviral drugs administration, pregnancy outcome, paediatric infection and birth weight were evaluated. Data were analysed using univariate analysis and binary logistic regression. Results: 678 HIV-infected were enrolled: 395 women received prophylactic regimen and 283 HAART regimen (115 started prior to conception, 168 started after the first trimester). Statistical analysis raised CD4+ T cell count<200/mm3 as the only significant predictive factor for an adverse pregnancy outcome (A.O.R.= 3.9, P= 0.03). Women on HAART started later presented major incidence of LBW infants. This group contained the largest percentage (73.6%) of severe immunodepressed women, with unknown HIV status. Conclusions: Advanced immunocompromised status is a predictive factor for adverse pregnancy outcome. Unknown HIV-status and CD4+ T cell count lower than 200/ mm3 were significantly associated with LBW of newborns from women on HAART started after the first trimester. HAART is not a significant risk factor for adverse pregnancy outcome or LBW.