icon-    folder.gif   Conference Reports for NATAP  
  Conference on Retroviruses
and Opportunistic Infections
February 12-16, 2022
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More Adverse Birth Outcomes With COVID Plus HIV in Botswana
  2022 CROI, February 12-16 and 22-24, 2022
Mark Mascolini
In Botswana women and neonates had higher rates of adverse birth outcomes if the mother had COVID-19, according to results of an 11,000-mother study [1]. Adverse outcome rates climbed highest when women had both COVID and HIV infection. Infants of COVID+/HIV+ mothers ran almost an 80% higher risk of any adverse outcome than infants of mothers with HIV but without COVID.
Both COVID and HIV may boost chances of adverse birth outcomes, but the combined risk with the two infections is not well defined. With high HIV prevalence among women in Botswana, Tsepamo Study researchers conducted this analysis of how COVID with or without HIV affects birth outcomes. (Adult HIV prevalence stands at about 20% in Botswana [2]).
Tsepamo conducts outcomes surveillance at government maternity sites throughout Botswana. The study was originally designed to weigh the impact of HIV infection and antiretroviral therapy on mothers and neonates and began tracking COVID status when the pandemic struck Botswana. This analysis considered data from 13 Tsepamo sites from September 1, 2020 through November 15, 2021. Using PCR or a rapid antigen test, the 13 sites routinely screened most women delivering babies during this period. The analysis included women with singleton deliveries, known HIV status, and a COVID screening test 14 days before and up to 3 days after delivery.
Among the 20,410 deliveries during the study period, 11,483 (56%) involved women screened for COVID, of whom 539 (4.7%) had COVID-19. In that COVID-positive group, 144 women (27%) had HIV infection and 392 (73%) did not. Women with HIV were significantly more likely to screen positive for COVID at delivery (P < 0.01).
Maternal mortality stood at 4% among women with COVID and 0.1% in women without COVID, results yielding more than a 30-fold higher death risk with COVID in an age-adjusted analysis (risk ratio [RR] 31.6, 95% confidence interval [CI] 15.4 to 64.7). Among women with HIV, COVID hiked mortality 23-fold (3% vs 0.1%, RR 23.3, 95% CI 5.3 to 102.8), while among women without HIV, COVID had an even stronger impact on maternal mortality (4% vs 0.1%, RR 35.6, 95% CI 15.7 to 81.0). The arrival of the SARS-CoV-2 Delta variant drove up maternal mortality risk with versus without COVID even higher (5% vs 0.1%, RR 56.3, 95% CI 20.5 to 154.7).
A maternal COVID diagnosis raised age-adjusted risk of several adverse birth outcomes in infants: any adverse birth outcome (34.5% vs 26.6%, RR 1.31, 95% CI 1.16 to 1.48), any severe adverse birth outcome (13.6% vs 9.8%, RR 1.39, 95% CI 1.11 to 1.73), preterm delivery (21.4% vs 13.4%, RR 1.60, 95% CI 1.35 to 1.90), and stillbirth (5.6% vs 2.7%, RR 1.97, 95% CI 1.37 to 2.84). Maternal COVID did not significantly affect very preterm delivery, small for gestational age, very small for gestational age, or neonatal death.
Comparing infants of women with HIV and COVID and infants of women with HIV but without COVID, adverse birth outcomes in infants were more frequent in those born to dually infected mothers: any adverse birth outcome (43.1% vs 30.4%, RR 1.78, 95% CI 1.47 to 2.16), any severe adverse birth outcome (15.3% vs 11.7%, RR 1.65, 95% CI 1.11 to 2.45), preterm delivery (25.5% vs 14.7%, RR 1.99, 95% CI 1.49 to 2.66), very preterm delivery (3.4% vs 2.9%, RR 2.02, 95% CI 1.06 to 3.87), and small for gestational age (22.0% vs 18.3%, RR 1.63, 95% CI 1.19 to 2.23).
COVID vaccination could not be factored into this analysis because maternal obstetric data did not include it, but fewer than 15% of women in Botswana were fully vaccinated during this study period. The highly contagious Omicron variant did not affect this analysis because it became the dominant variant after the study period. The Tsepamo investigators also noted that the healthcare demands created by COVID could have affected child-delivery care in this study group.
1. Jackson-Gibson M, Diseko M, Caniglia E, et al. The impact of COVID-19 on adverse birth outcomes in Botswana by HIV status. 2022 CROI, February 12-16 and 22-24, 2022. Abstract 28.
2. UNICEF. Botswana. https://www.unicef.org/botswana/hiv