As perinatally HIV-infected (PHIV) women reach reproductive age, there is an increasing number who become pregnant. This is a retrospective cohort study of HIV-infected women who delivered from June 2007 to July 2012 at our institution. Maternal demographics, HIV characteristics, and obstetric and neonatal outcomes were compared. 20 PHIV and 80 SHIV pregnancies were reviewed. The groups had similar CD4+ counts, prevalence of AIDS, and use of antiretrovirals (ARV) at initiation of obstetrical care. PHIV women were significantly more likely to be younger, have a detectable viral load (35% versus 74%, P < 0.01), and have HIV-genotype resistance (40% versus 12%, P < 0.01) than the SHIV women. The median gestational age at delivery (38 weeks) and rates of obstetrical and neonatal complications were similar between the groups. While the overall rate of cesarean delivery (CD) was similar, the rates for CD due to HIV were higher in the PHIV group (64% versus 22%, P < 0.01). There was one case (5.3%) of mother-to-child transmission in the PHIV group versus two cases (2.6%) in the SHIV group. In our population, PHIV pregnant women have a higher rate of HIV-genotype resistance and higher rate of detectable viral load leading to a higher rate of CD secondary to HIV.

/pdf/comparison-of-pregnancies-between-perinatally-and-sexually-242m2dmz5c.pdf

Comparison of pregnancies between perinatally and sexually HIV-infected women: an observational study at an urban hospital.

The first cases of mother to child transmission of human immunodeficiency virus (HIV) were described more than two decades ago and since then several thousands more have been reported in western countries. In the early 1980s the majority of perinatally acquired HIV children did not survive beyond childhood. However combined antiretroviral therapy (ART) for perinatally HIV-acquired children has prolonged their survival and in the past 2 decades, many have reached adulthood. As the perinatally HIV-infected females become sexually active, they are in turn at risk for pregnancy and of transmitting HIV infection to their children. A considerable proportion of this population appears to engage in unprotected sexual intercourse leading to teenage pregnancies, STDs, and abnormal cervical cytology despite frequent contact with HIV health care providers and clinics. Currently there is a paucity of data regarding pregnancy and neonatal outcomes in HIV perinatally infected women. As increasing number of pregnancies will occur among this population we must continue to monitor and focus on their reproductive health issues to improve perinatal and long-term maternal outcomes. This paper will summarize our current knowledge about reproductive health issues and identify areas for future inquiry.

/pdf/thirty-years-later-pregnancies-in-females-perinatally-1prfm7qxmh.pdf

Thirty Years Later: Pregnancies in Females Perinatally Infected with Human Immunodeficiency Virus-1

Background An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus. The aims of this study were to describe the prevention of mother-to-child transmission strategies in PHIV women and the infant outcomes in the Madrid Cohort of HIV-infected mother-infant pairs. Methods All PHIV pregnant women registered in the Cohort that gave birth from 2000 to 2015 were included in the study. Results Twenty-eight pregnancies in twenty-two perinatally infected women were registered. Most women were Caucasian and heavily treatment-experienced. Nine cases (32.1%) were at high risk of HIV mother-to-child transmission. Maternal HIV-1 viral load was detectable close to delivery in four women (14.3%). The management of these cases was described, and the treatment strategies were discussed. None of the newborns acquired HIV infection. Eight infants (28.6%) were small for gestational age. Conclusions This study included a large series of pregnancies among PHIV women attended according to a youth-centered care model. The challenges in the management of this population by health-care providers were described. Specific strategies to minimize perinatal transmission risks should be addressed in future collaborative studies.

Pregnancy outcomes in perinatally HIV-infected young women in Madrid, Spain: 2000-2015.

Background Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women. Aim To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil. Methods A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group. Results Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p = 0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR = 18.66, 95%CI = 5.52–63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group. Conclusion Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.

Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro.

Introduccion: La terapia anti-retroviral en pediatria (TARV), cambio el pronostico de la enfermedad, permitiendo embarazarse a mujeres jovenes infectadas por transmision vertical (TV). Objetivos: Conocer las caracteristicas clinico-inmunologicas de las mujeres embarazadas, tratamientos recibidos, condicion al embarazo y seguimiento de sus recien nacidos. Material y Metodo: Se efectuo un protocolo, evaluando etapas clinico-inmunologicas en el embarazo, TARV usadas, protocolo de prevencion de transmision vertical (PPTV) y seguimiento de los ninos hasta 18 meses. Resultados: De 358 pacientes con infeccion por VIH adquirida por TV, cinco mujeres se embarazaron, con edades entre 14 a 24 anos, embarazos que fueron controlados por el equipo de salud, encontrandose en etapa clinico-inmunologica N2 a C3. Habian recibido dos a cinco esquemas de TARV. Se efectuo PPTV completo en todos los binomios. Las cargas virales previas al parto fluctuaron entre indetectable y 4.700 copias ARN/ml. Nacieron por cesarea cinco ninos vivos, cuatro de termino y uno con 34 semanas de gestacion. Todos recibieron zidovudina (AZT) durante seis semanas. Los CD4 a las 72 h de vida fluctuaron entre 48 y 74,6%. Ninguno de los ninos adquirio la infeccion por VIH en forma vertical. Solo dos presentaron anemia leve. Conclusiones: Las expectativas de madres con infeccion por VIH de adquisicion vertical de tener hijos sanos son semejantes a las infectadas por transmision horizontal, al usar PPTV.

/pdf/young-women-with-hiv-infection-acquired-by-vertical-5g0acl7d8c.pdf

Young women with HIV infection acquired by vertical transmission: Expectations of having uninfected children

Pregnancies in Perinatally HIV-Infected Young Women and Implications for Care and Service Programs

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Pregnancies in Perinatally HIV-Infected Young Women and Implications for Care and Service Programs