CHORIOAMNIONITIS AND PREGNANCY OUTCOME IN HIV-INFECTED AFRICAN WOMEN

Objective: To assess the role of chorioamnionitis (CAM) on pregnancy o utcome in HIV-1-infected (HIV-positive) pregnant women, treated for se xually transmitted diseases (STDs), during the last trimester of pregn ancy in Kigali, Rwanda. Methods: At inclusion in a prospective cohort, from July 1992 to August 1993, 561 pregnant women between 24 and 28 w eeks were systematically screened for HIV infection, STDs, anemia, mal aria, and hepatitis B infection; a CD4 lymphocyte count was performed. Until delivery, each woman enrolled had a monthly clinical follow-up with STD treatment when needed. The pregnancy outcome was recorded. Di agnosis of CAM was based on histologic examination of the placenta. Re sults: Among the 275 placentas of HIV-negative women and 286 placentas of HIV-positive women examined, CAM was diagnosed (CAM-positive) in 2 7 HIV-positive women (9.8%) and in 28 HIV-negative women (9.8%). No st atistical association was found between CAM and the following variable s, independent of the HIV serostatus: age, parity, hepatitis B, anemia , STDs, and immune deficiency. Among HIV-negative women, CAM was signi ficantly associated with prematurity (relative risk [RR] = 3.0; 95% co nfidence interval [CI] = 1.5-6.3), stillbirth (RR = 4.2; 95%CI = 1.6-1 1.0) and premature rupture of membranes (RR = 2.9; 95%CI = 1.4-6.1). A mong HIV-positive women, early neonatal mortality was the only adverse outcome associated with CAM (RR = 2.0; 95%CT = 1.6-11.0). Conclusions : In our study, the prevalence of CAM was low and no risk factor of CA M was identified, a probable consequence of the control factor of STDs , CAM was strongly associated with adverse pregnancy outcomes in HIV-i nfected women, reflecting a possible deleterious effect of HIV.