D-Dimer, CRP, MDA, and Aminotransferases Levels of HIV Positive Pregnant Women on HAART as Predictors of Neonatal Jaundice and Low Birth Weight

Abstract

Background: The administration of highly active antiretroviral therapy (HAART) during pregnancy, particularly in the third trimester, has proven effective with minimal teratogenic effects. This longitudinal study evaluates the impact of two commonly prescribed HAART regimens Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP) and Tenofovir/Lamivudine/Efavirenz (TDF/3TC/EFV) on specific biochemical markers in HIV positive pregnant women and their potential predictive value for neonatal jaundice and low birth weight. Methods: A total of 105 pregnant women in their third trimester were enrolled: 35 HIV-negative controls and 70 HIV positive women equally distributed between the two HAART regimens. Serum levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), D-dimer, C-reactive protein (CRP), and Malondialdehyde (MDA) were assessed in the mothers. Total bilirubin of neonates was evaluated using a standard spectrophotometric method at 72 hours post-delivery. Results: There was no significant age difference between HIV positive and control groups (32.17 ± 4.81 vs. 32.14 ± 6.22 years; p = 0.117). HIV positive women on AZT/3TC/NVP exhibited significantly higher AST levels compared to those on TDF/3TC/EFV (31.46 ± 10.64 vs. 25.20 ± 8.73; p = 0.002) and controls (31.46 ± 10.64 vs. 20.23 ± 4.59; p < 0.001). Conversely, D-dimer and CRP levels were significantly elevated in the TDF/3TC/EFV group compared to AZT/3TC/NVP (p < 0.001). Strong positive correlations were observed between maternal D-dimer (r = 0.848), CRP (r = 0.761), and age (r = 0.723) with neonatal bilirubin levels at 72 hours after birth. Multiple logistics regression analysis revealed that D-dimer (Odds Ratio [OR]: 1.003; 95% CI: 0.999 – 1.006), C-reactive protein (OR: 0.032; 95% CI: 00.004 – 0.274) and Alanine aminotransferase (OR: 1.234; 95% CI: 1.034 – 1.474) predicted an abnormal fetal outcome between third trimester females on TDF/3TC/EFV and AZT/3TC/NVP. Conclusion: These findings suggest that HAART-associated biochemical changes in late pregnancy may influence neonatal outcomes. Inclusion of D-dimer, CRP, and aminotransferases as part of drug effect monitoring and routine antenatal screening, could serve as valuable predictors of adverse neonatal effects in HIV positive pregnancies.