Effect of combined HIV and Substance use during pregnancy on placental efficiency.

We examined the impact of combined HIV exposure and substance use disorder (SUD) on perinatal outcomes and placental pathology in a retrospective cohort of 268 pregnancies (2015-2024). Participants included HIV-only, SUD-only, combined HIV/SUD, and unexposed groups. The primary outcome was placental efficiency score, analyzed using multivariate regression. Nicotine (52.6%) and medications for opioid use disorder (82.8%) were the predominant exposures. The concurrent HIV/SUD group demonstrated the lowest placental efficiency, even after adjusting for hypertensive disorders [mean difference -1.7 (95% CI -3.2, -0.3)]. Combined HIV and SUD exposure may impair placental function and contribute to adverse perinatal outcomes, warranting further investigation.