Predictors of Adverse Pregnancy-Fetal Outcomes and the Association with Maternal HIV Immune Reconstitution Inflammatory syndrome among Women Attending Selected Public Hospitals, Nairobi, Kenya

Abstract

With the enhanced rollout of antiretroviral therapy (ART), HIVimmune reconstitution inflammatory syndrome (IRIS) may remain a public health issue of major concern, moreover in pregnancy. In Kenya, no studies on the incidence and predictors for adverse pregnancy-fetal outcomes with IRIS among ART-naïve women. This study sought to estimate the incidence of, and, determine the predictors for adverse pregnancy-fetal outcomes and the association with maternal-HIV-IRIS. With a prospective cohort design, study subjects were recruited and followed from the end of first trimester for six and half months after confirming their HIV status as positive, on ART treatment with a defined case of HIV-IRIS, from two selected Public Hospitals in Nairobi County, Kenya. A total of 204 women from both cohorts were included in the ultimate analysis post subsequent elimination process at a sample ratio of 1:1. The participants were followed until postpartum through delivery stage. Bivariate analyses with a chi-square test was used to measure the association between the variables at p-value < 0.05 and multiple logistic regression was performed to identify the independent predictors of adverse pregnancy-fetal outcomes (APFOs). The APFOs incidence, both cumulative and rate was 26.47% and 0.012 per person’s week and 10.78% and 0.0045 per person’s week among IRIS cases and non-IRIS cases respectively. The incidence rate of APFOs was higher at delivery time, 164/10000 person’s week with a cumulative incidence of 18.6%. Overall, 38 (18.6%) APFOs ocurred, most, at delivery and within two weeks after delivery, with LBW, mostly being noted; LBW (10.8%), PTB (2.9%) and LBW (7.8%), PTB (2.9%) in IRIS and non-IRIS exposed, respectively. Miscarriage was the most common APFO before delivery. Two newborn intensive care unit admissions and one severe newborn jaundice in IRIS and non-IRIS cases respectively were noted within two weeks post-delivery. Over the entire period, IRIS cases had three times, odds of experiencing an APFO compared to non-IRIS cases [OR=3; 95% CI: 1.4-6.4; P=.004], at, bivariate analysis but the multiple logistic regression analysis did not sustain it [AOR=1.6; 95% CI: 0.4-5.8; P =.508], a similar trend of experiencing an APFO at the delivery time among IRIS cases compared to non-IRIS at bivariate analysis [OR=2.5; 95% CI: 1.295-8.121; P=.006]. Other outcome measurement times; at the end of the second trimester and within two weeks after delivery, had [OR=2.1; 95% CI: 0.502-8.482; P=.16] and [OR=2.4; 95% CI: 0.216- 27.286; P=.71] respectively. Multiple logistic regression revealed the HIV-RNA viral load of above 50 copies/ml at baseline [AOR=2.7; 95% CI: 1.2-6.3; P=.017], an hypertensive event implicated by maternal placental syndrome [AOR=0.1; 95% CI: 0.0-1.0; P =.052] and , majorly, the general health of the woman at delivery stage [AOR= 4; 95% CI: 4.0:1.8-9.1; P=.001] as independent predictors of APFOs. This study demonstrates a higher incidence of APFOs with maternal HIV-IRIS diagnosed women. Empirical research should study interventions aimed at minimizing the associated risk factors identified in this analysis for their effects on reducing APFOs incidence. Public health and to an extent, clinical interventions should also target the modifiable risk factors associated with APFOs in ART-naive pregnant women, as an integrative approach with PMTCT, to ameliorate any possible adverse pregnancy-fetal incidences.