After having been HIV+ for 14 years, I gave birth to a premature baby at 29 weeks gestation due to placenta insufficiency. Could my HIV status have caused this complication? My baby is 11 months old and HIV- but I'm asking this question because and I would like to have another child as my CD4 count is above 450 and viral load remains undetectable.

Placental insufficiency is a pretty general term for a condition in which the placenta does not do an adequate job of providing nutrients or removing waste from the baby. Placental insufficiency commonly leads to small babies (intrauterine growth retardation) but not always to prematurity. There are many different conditions associated with placental insufficiency (drug use, abnormal implantation of the placenta, high blood pressure, etc). Sometimes, however, placental insufficiency occurs without explanation and does not affect subsequent pregnancies. If you are asymptomatic with undetectable viral load and good CD4 count, it is unlikely that your HIV infection is associated with the placental insufficiency. It is important for you to discuss your case with your care provider to better understand what might have contributed to the placental insufficiency in your last pregnancy and what can be done in future pregnancies to try to avoid this.