Maternal and Perinatal Outcomes Associated with Maternal HIV Infection at Nelson Mandela Academic Hospital, Eastern Cape Province, South Africa

Background: South Africa has one of the largest HIV epidemics globally, with over 7.5 million people living with HIV. The Eastern Cape Province has a high antenatal HIV prevalence (36.5%), second only to KwaZulu-Natal (40.3%). Although the widespread use of antiretroviral therapy (ART) has significantly reduced HIV-related mortality and vertical transmission, adverse maternal and perinatal outcomes remain a public health concern. This study aimed to assess the effect of maternal HIV infection on maternal and neonatal outcomes in the era of universal ART at Nelson Mandela Academic Hospital. Methods: A retrospective case–control study was conducted using clinical records of 600 women (300 HIV-positive and 300 HIV-negative) who delivered in 2019. Maternal demographic, obstetric, clinical, and neonatal outcomes were compared between groups. Categorical variables were presented as frequencies and percentages, while continuous variables were summarized as means ± standard deviations. Associations were assessed using Chi-square tests, multivariate logistic regression, and Cox proportional hazards models. Statistical significance was defined as p < 0.05. Results: HIV-positive women had significantly higher rates of anaemia (38% vs. 23%), hypertensive disorders, and inadequate antenatal care attendance. HIV exposure was associated with increased risks of adverse neonatal outcomes, including preterm birth (26.3% vs. 20.3%), low Apgar scores, and stillbirths. Low birth weight was an independent predictor of neonatal mortality (hazard ratio (HR) = 2.40, p < 0.001). Although vertical transmission was low (1.7%), incomplete infant testing data (8.6%) limited a comprehensive assessment. ART initiation during pregnancy was associated with modestly improved maternal and neonatal outcomes compared to delayed initiation. Conclusions: Maternal HIV infection remains significantly associated with adverse maternal and neonatal outcomes despite widespread ART coverage. From a public health perspective, these findings highlight the need to strengthen integration of HIV care within antenatal services, promote early ART initiation, and improve continuity of maternal and neonatal care to optimize outcomes in high-burden settings.