(104) Adverse Maternal Obstetric Outcomes by HIV Status in Botswana: Data from the ‘Treat-All’ HIV Era

Botswana has achieved 90-90-90 targets to eliminate HIV and led the region in initiating antiretroviral therapy (ART) at the time of HIV diagnosis (‘treat-all’). The impact of HIV and ART on neonatal outcomes have been extensively studied, yet data on maternal obstetric outcomes are limited. This study aimed to evaluate maternal outcomes in a large cohort with high HIV prevalence after implementation of a ‘treat-all’ policy.


Study Design:

Data were collected at the time of delivery from the medical record between November 2021 to February 2023; outcomes were recorded in the Tsepamo Birth Outcomes Surveillance and Safe Birth studies at Princess Marina Hospital in Botswana. We evaluated maternal obstetric morbidities and maternal mortality at the time of hospital discharge by HIV status.


Results:

We included 6982 participants; 1336 (19%) were pregnant people with HIV (PHIV). 1288 (96%) were on ART, and 439 (93%) of those with known ART regimen were on tenofovir, lamivudine, and dolutegravir (TLD). Of 473 with known CD4 counts, 325 (69%) were >500 cells per µL, 128 (27%) were 200-500 cells per µL, and only 20 (4%) were < 200 cells per µL. Of 898 with known viral loads, 836 (93%) were undetectable. Overall rates of pre-eclampsia were the same between groups (p=0.47). There were no differences in rates of hemorrhage, infections, acute pulmonary or cardiac conditions, or death in people with and without HIV (all p≥0.24). Although an overall rare outcome, acute kidney injury was slightly more common in PHIV (0.4% versus 0.1%, p = 0.04).

 

Conclusion:

Rates of adverse maternal obstetric outcomes were similar in people with and without HIV in the treat-all ART era where a majority were virally suppressed on TLD, except for a 3-fold increased risk of AKI for PHIV though numbers were small. This study demonstrates that treat-all with first-line TLD leads to similar maternal obstetric outcomes for PHIV.