Outcomes of pregnancy and HIV status of infants born to women with HIV in Larkana, Pakistan: a ten-year retrospective study (2011–2021)

Introduction: An extensive HIV outbreak among children in Larkana, Pakistan in 2019 resulted in establishment of HIV screening and paediatric HIV services. We investigated pregnancy outcomes and HIV status of infants born to women living with HIV (WLWH) in Larkana. Methods: A retrospective study was conducted across two clinical centers in Larkana District, Sindh province. A list of WLWH who accessed antenatal care (ANC) from January 2011 up to December 2021 was obtained, obstetric and HIV data were retrieved from hospital records, and descriptive data analysis was performed. Results: Of 328 WLWH who accessed ANC at least once, we analyzed 237 (72%) women. Median age at HIV registration was 27 (IQR:23–32) years; 30.4% of WLWH were infected through blood products or contaminated needles, and 29 of the 207 tested had Hepatitis B or C co-infection. At HIV care registration, 41.4% had a CD4 count < 350 cells/µl. Overall, 178/237 WLWH had 509 previous pregnancies: 5.9% and 1.8% respectively resulted in miscarriages and stillbirths. Of 470 previous live births, 74/354 (20.9%) had died by the time WLWH registered for their latest pregnancy (vital status was not recorded for the other 116 children). Of the 255 children who were alive and had an HIV test, 21.2% tested HIV-positive. Data on outcomes of current pregnancy were available for 213/237 women, 2 being miscarriages and 9 being stillbirths. The median birthweight was 2.5(IQR:2.3–2.6) kg. 99% of infants received HIV prophylaxis within a week of birth. HIV testing was documented for 134 children, of whom 107 had an HIV test and 5 (4.7%) tested HIV positive, 4 within 2 months of birth and one in the 3rd year of life. Conclusions: The findings underscore the need for specialist obstetric care for WLWH, strengthened antenatal HIV testing, and monitoring of children born to women with HIV.