Abstract

This study described the incidence of adverse pregnancy-fetal outcomes (APFOs) in Kenyan HIV-infected ART-naive pregnant women and examined the relationship between maternal HIV-immune reconstitution inflammatory response syndrome (IRIS) /related risk factors and APFOs. This prospective cohort study was carried out among 102 HIV-IRIS-exposed and 102 HIV-IRIS non-exposed pregnant women after initiating ART. Both groups were enrolled from two hospitals in Nairobi County, Kenya in July 2019. Data were collected in a standard structured form, including maternal and demographic characteristics, HIV-IRIS status, HIV-IRIS related factors, and their pregnancy outcomes. APFOs were assessed by maternal HIV-IRIS status and HIV-IRIS related factors using logistic regression analysis. The incidence of APFOs, cumulatively over the entire period, in IRIS versus non-IRIS, was 26.47% and 10.78% and the rates were 0.012 and 0.0045 per person’s week, respectively. The RRs of APFOs was double-fold among IRIS cases compared to non-IRIS cases RR (2, 2.69, and 2) respectively. IRIS cases were three times more likely to experience an APFO compared to non-IRIS cases [OR=3; 95% CI: 1.4-6.4; P=.004]. At specific visit times, APFOs were associated with IRIS mostly at delivery (P=0.006) as compared to other times; [OR=2.1; 95%CI: 0.502-8.482; P=.0.16]; [OR=2.5; 95%CI: 1.295-8.121; P=.0.006] and [OR=2.4; 95%CI: 0.216-27.286; P=0.71]. APFOs with higher frequencies at specific points among IRIS and non-IRIS cases were; at the end of the second trimester; miscarriage, 3 (2.9%), 2 (2.0%), at delivery; LBW 11 (10.8%), 3 (2.9%) and within two weeks after delivery; newborn intensive care admission (newborn jaundice) 2 (2.0%), 1 (1.0%), respectively all with p> .05 about HIV-IRIS. LBW showed the highest incidence/significance relative to IRIS [OR=3.8; 95%CI: 1.079, 14.754; P=0.0019]. Multiple logistic regression for the entire follow-up period dropped maternal HIV-IRIS and revealed HIV-RNA viral load at baseline of above 50 copies/ml [AOR=2.7; 95%CI: 1.2-6.3; P=.017], closely, maternal placental syndrome (MPS) characterized by hypertensive events [AOR=0.1; 95%CI:0.0-1.0; P = .052] and mother’s general health during delivery [AOR= 4; 95%CI: 4.0:1.8-9.1;P=.001] as independent predictors of APFOs. Maternal HIV-IRIS was associated with significantly increased risks of APFOs. Modifiable risk factors should be monitored and controlled in clinical practice more so towards delivery.