Outcome of pregnancy in the era of highly active antiretroviral: a 10‐year experience in Southern Ireland
In: Journal of the International AIDS Society, Band 15, Heft S4, S. 1-1
ISSN: 1758-2652
IntroductionSince the introduction of HAART the desire to become a mother in women with HIV has become a viable option due to the drastic reduction in vertical transmission. The aim of this study was to look at the epidemiology, clinical characteristics, and safety of antiretroviral drugs and rate of vertical transmission in our cohort in the Munster region, Ireland.MethodsWe retrospectively reviewed all pregnant women with HIV who attended the ID clinic from January 2002 to April 2012. Patients' demographics, pertinent laboratory data, and pharmacy records were reviewed and statistically analysed.Results105 HIV‐positive women, with a total of 165 pregnancies, were seen from January 2002 to April 2012 at Cork University Hospital: 46 patients were previously known to be HIV‐infected at their first pregnancy and 59 were diagnosed during antenatal screening (median of 32 week gestation at diagnosis). The median age at the time of pregnancy was 32 and the HIV transmission was 90% sexual: 39 women were from Europe/Asia and 66 were African; only two women were HCV co‐infected and one was HBV co‐infected. Of the patients diagnosed with HIV prior to pregnancy, 13 were on treatment, all of whom had no detectable virus at the start and during pregnancy. The median CD4+ at the start of pregnancy was 490 cells/µl. The median weeks of gestation at the start of HAART was 28 before 2006 and 20 after 2006, in accordance with National Guidelines. The HAART regime used was in line with current Guidelines. 18 pregnancies ended in miscarriage before week 12 gestation and 2 pregnancies resulted in intrauterine death at 28 weeks. 145 pregnancies progressed to delivery at full term but 10 infants were born before the 37th week, with one baby born at 23 weeks: 63 had SVD and 82 underwent C‐section, of whom 12 emergency C‐section due to prolonged membrane rupture. Most of the C‐sections were planned due to obstetric reasons. 2 infants were born HIV+: in one case the mother was a late presenter at 38 of gestation; and in other the mother had poor compliance with viral load detectable at the time of labour. The overall number of pregnancies per year has been stable over the ten years (average of 14 pregnancies per year).ConclusionThe use of cART with high level of adherence and a close clinical management during pregnancy has shown to dramatically reduce the vertical transmission of HIV in our cohort.