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