Clinical and immunological characteristics associated with adverse perinatal outcomes among pregnant people living with HIV: a retrospective cohort study

Objectives To evaluate clinical and immunological characteristics associated with adverse perinatal outcomes among pregnant people living with HIV (PPLH).Methods This retrospective cohort study included singleton pregnancies of PPLH followed between 2006 and 2019 at a Brazilian tertiary referral center for high-risk pregnancies. Clinical and HIV-related data, including viral load (VL), CD4+ cell count, lymphopenia, and opportunistic infections (OI), were obtained from medical records. The primary endpoint was a composite adverse perinatal outcome defined as preterm birth (PTB) and/or low birth weight (LBW). Multivariable logistic regression was performed to identify factors independently associated with adverse outcomes.Results A total of 167 pregnancies were analyzed. The prevalence of the composite adverse perinatal outcome was 28.1%. Adverse outcomes were associated with previous opportunistic infection (p = 0.049), gestational opportunistic infection (p = 0.019), higher baseline viral load (p = 0.049), baseline lymphopenia (p = 0.002), lower body mass index (p = 0.044), lower CD4 cell count at 34 weeks (p = 0.014), and lack of viral suppression at 34 weeks (p = 0.008). In multivariable analysis, baseline VL (adjusted OR = 1.73, 95% CI = 1.10–2.99) and baseline lymphopenia (adjusted OR = 7.67, 95% CI = 1.37–42.8) remained independently associated with adverse perinatal outcomes.Conclusions Adverse perinatal outcomes remain frequent among PPLH. Baseline viral load and lymphopenia were independently associated with PTB and/or LBW, highlighting the importance of early viral suppression and immune stabilization during pregnancy.