Data on the impact of chronic hepatitis infections on the immunovirological response to antiretroviral therapy (ART) and obstetric outcome in HIV-infected pregnant women are scarce and conflicting.
We analyzed data from all HIV-1 infected women included in the national ANRS-CO1 French Perinatal Cohort between 2005 and 2013. Prenatal testing for HBV and HCV infections was performed in most cases (95%). HBV/HIV and HCV/HIV co-infected mothers were compared with those infected only with HIV; the rare mothers with all three infections were excluded. Bivariate and multivariate analyses were performed.
Among 6548 pregnancies, the overall prevalences of HCV (RNA+) and HBV (HBsAg+) infections were 3.2% [95%CI: 2.9-3.8] and 6.9% [6.2-7.5], respectively. As expected, HCV infection was strongly associated with a history of drug use, whereas HBV infection was six times more frequent in women originating from Sub-saharan Africa compared with those from mainland France. HIV viral load, CD4 cell count at pregnancy initiation and HIV care were similar in co- and mono-infected HIV mothers except, for ART, with 90% of HBV/HIV co-infected women receiving tenofovir and /or 3TC or FTC, with potential to efficiently decrease HBV viral load. No efficient treatment against HCV was prescribed in the HCV/HIV group.
HCV coinfection was significantly associated with poorer HIV immunovirological status during the third trimester (Fig), and higher risks of gestational diabetes (OR=1.9 [1.0-3.7], p=0.05), cholestasis (OR=8.9 [4.9 – 16.3], p<0.001) and preterm delivery (OR=3.3 [1.9-5.5], and OR=4.2 [2.3-7.9], p<0.001) for moderate and very preterm delivery, respectively: p<0.001). The association with prematurity remained significant after adjustment for known risk factors, HIV viral load and antenatal complications (aOR=2.3 [1.1-5.0], p=0.03). In HBV/HIV women no association was found with any of these outcomes.
In HIV-infected pregnant women, chronic HBV infection, efficiently treated, had no major impact on mother health during pregnancy. In contrast, HCV co-infected mothers, without any efficient treatment against HCV, showed a poorer HIV immunovirological response to ART and higher risk of antenatal complications and prematurity. This suggests that efficient control of HCV activity, before conception, as likely to be obtained in HBV infection, may limit the deleterious impact of co-infection.