The HIV paradox: perinatal mortality is lower in HIV-positive mothers. A field case-control study in Ethiopia

Objective: Sub-Saharan African countries have the highest perinatal mortality rates. Although HIV is certainly a risk factor for perinatal death, ART programmes have been associated with better outcomes. We aimed to investigate how maternal HIV affects perinatal mortality. Methods: We carried out a nested case-control study at the Saint Luke Hospital, Wolisso, Ethiopia. Data on sociodemographic characteristics; current maternal conditions; past obstetric history; ANC services utilisation were collected. The association between perinatal mortality and HIV was assessed with a logistic regression adjusting for potential confounders. Results: A total of 3,525 birthing women were enrolled, including 1,175 cases and 2,350 controls. Perinatal mortality was lower among HIV-positive women (18.3% vs 33.6%; p=0.007). The crude analysis showed a protective effect of HIV (OR=0.442; 95%CI:0.241-0.810) which remained after adjustment (aOR=0.483; 95%CI:0.246-0.947). Amongst HIV-negative women, access to ANC for women from rural areas was almost half (18.8% vs. 36.2%; p<0.001), whereas in HIV-positive women no differences were noted (p=0.795). Conclusion: Among HIV-positive mothers, perinatal mortality was halved and differences in access to ANC services by area were eliminated. These data highlight the benefits of integrating ANC and HIV services in promoting access to the health care system, reducing inequalities and improving neonatal mortality.