Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study

Marina Lumbreras Areta; Federico E Migliorelli Falcone; Christoph Rudin; Christian R Kahlert; Paolo Paioni; Marc U Baumann; Katharine Darling; Christian Polli; Begoña Martinez de Tejada

doi:10.1111/hiv.13652

Trends in preterm birth in women living with HIV in Switzerland over the last three decades: A multicentric, prospective, cohort study

HIV Med. 2024 May 16. doi: 10.1111/hiv.13652. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
² BCNatal-Fetal Medicine Research Center, Hospital Clínic and Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
³ University Children's Hospital Basel, Basel, Switzerland.
⁴ Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland.
⁵ Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland.
⁶ Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, Bern, Switzerland.
⁷ Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
⁸ Department of Obstetrics and Gynecology, Regional Hospital, Lugano, Switzerland.
⁹ Faculty of Medicine, University of Geneva, Geneva, Switzerland.

PMID: 38752462
DOI: 10.1111/hiv.13652

Abstract

Background: HIV infection and its management during pregnancy to reduce perinatal transmission has been associated with preterm birth (PTB). This management has drastically changed. We aimed to evaluate changes in rates of PTB over 34 years in women living with HIV (WLWH) in Switzerland, and to identify factors and interventions associated with these changes.

Methods: We analysed data from 1238 singleton pregnancies, prospectively collected by the Swiss Mother and Child HIV Cohort Study (MoCHiV) and the Swiss HIV Cohort Study (SHCS) between 1986 and 2020. Rates of PTB in this cohort were compared with that of the general Swiss population for three time periods according to changing treatment strategies recommended at the time. We evaluated the association of PTB with sociodemographic, HIV infection and obstetric variables in uni- and multivariate logistic regression.

Results: Rate of PTB in WLWH was highest prior to 2010 (mean 20.4%), and progressively decreased since then (mean 11.3%), but always remained higher than in the general population (5%). Older maternal age, lower CD4 count and detectable viraemia at third trimester (T3), drug consumption and mode of delivery were all significantly associated with both PTB and period of study in univariate analysis. There was no association between PTB and type of antiretroviral regimen. No difference was found in the rate of spontaneous labor between PTB and term delivery groups. Only higher CD4 count at T3 and vaginal delivery were significantly associated with a decrease in PTB over time in multivariate analysis.

Conclusions: Preterm birth in WLWH in Switzerland has drastically decreased over the last three decades, but remains twice the rate of that in the general population. Improved viral control and changes in mode of delivery (vaginal birth recommended if viral loads are low near birth) have led to this progress.

Keywords: HIV/AIDS; antiretroviral therapy; epidemiology; preterm birth.

Grants and funding

866/Swiss HIV Cohort Research Foundation