Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital: a 30-year retrospective study

Abstract

The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985-1994 vs. 34 years in 2005-2014), in the proportion of foreigners (none in 1985-1994 vs. 27/70 (38·6%) in 2005-2014), and a decrease in intravenous drug use (75·2% (91/121) in 1985-1994 vs. 12·9% (9/70) in 2005-2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995-2004 vs. 92·2% (59/64) in 2005-2014) and in HIV-RNA <50 copies/ml at delivery (19·2% (5/26) in 1995-2004 vs. 82·3% (53/64) in 2005-2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9·1%, which increased to 92·3% from 2004 to 2015. Twelve (10·1%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8·3%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (<37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17·1% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2·7; 95% confidence intervals (CI) 1-7·8 and OR 2·6; 95% CI 1·1-6·7, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3·1; 95% CI 1·4-6·8). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA.

Prevalence and outcomes of pregnancies in women with HIV over a 20-year period

“…We also observed an increase in age at pregnancy in WWH, but women in East Europe were younger than elsewhere [15]. A recent increase in maternal age was also noted by other HIV cohorts in Europe [21,22].…”

Roles of TGF-β1 in Viral Infection during Pregnancy: Research Update and Perspectives

“…In the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child ranges from 15% to over 40% [ 58 , 61 ]. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route, the transmission rate amounted to less than 2% or even decreased to almost zero in some settings, including free access to antiretroviral therapy [ 60 , 96 , 129 , 130 , 131 , 132 ]. Trophoblasts are unlikely to be infected with HIV or with low viral production, and vertical transmission is thought to be through CD4+ endothelial tissues or CD4+ Hofbauer cells [ 98 , 133 , 134 , 135 , 136 ].…”

Viremia copy-years and risk of estimated glomerular filtration rate reduction in adults living with perinatal HIV infection

“…Since the early 2000s, there has been a gradual reduction of perinatal HIV infection (PHIV), owing to the extensive use of modern antiretroviral therapy (ART) in pregnant women and prophylaxis in newborns [ 1 , 2 ]. Parallel to the declining prevalence of perinatal HIV infection (PHIV) in the youngest age group, there has been an increase in the number of adolescents and young adults living with HIV, whose better quality of life and longer survival periods can be attributed to the immune-virological success of modern ART [ 3 , 4 ].…”