Diagnosis of HIV infection in pregnancy: data from a national cohort of pregnant women with HIV in Italy

Floridia, Marco; Ravizza, Marina; Tamburrini, Enrica; Anzidei, Gianfranco; Tibaldi, Cecilia; Maccabruni, Anna; Guaraldi, Giovanni; Alberico, Salvatore; Vimercati, Antonella; Antoni, Anna; Ferrazzi, E.

doi:10.1017/s0950268806006066

Cited by 40 publications

(29 citation statements)

References 13 publications

(7 reference statements)

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“…1 Moreover, family planning services are not always provided to women with HIV, and the proportion of unintended pregnancy is high. 11,12 Within this context, unintended pregnancy in women already on treatment frequently leads to periconception exposure to contraindicated or incompletely evaluated drugs. 13 Given the above premises, it remains important to collect data in national and international cohort studies and registries of pregnant women with HIV.…”

Section: Introductionmentioning

confidence: 99%

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Floridia

Mastroiacovo²,

Tamburrini

et al. 2013

BJOG

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Objective We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection.Design Observational study.Setting University and hospital clinics.Population Pregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy.Methods The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses.Main outcome measures Birth defects, defined according to the Antiretroviral Pregnancy Registry criteria.Results A total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9-4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9-4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and firsttrimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51-1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51-1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56-2.55; protease inhibitors, OR 0.92, 95% CI 0.43-1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%).Conclusions This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.

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Section: Introductionmentioning

confidence: 99%

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Floridia

Mastroiacovo²,

Tamburrini

et al. 2013

BJOG

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“…13 Only HIV-positive pregnant women are included, and no specific guidance is given for treatment of HIV infection or prophylaxis for mother-to-child transmission, which are decided by the treating physician. Laboratory and clinical data are collected from hospital records, following the women's consent based on a patient information sheet approved by the competent Ethics Committee (of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani in Rome, ref.…”

Section: Methodsmentioning

confidence: 99%

Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment

Baroncelli

Pirillo

Tamburrini

et al. 2015

AIDS Research and Human Retroviruses

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There is limited information on full viral suppression and low-level HIV-RNA viremia in HIV-infected women at the end of pregnancy. We investigated HIV-RNA levels close to delivery in women on antiretroviral treatment in order to define rates of complete suppression, low-level viremia, and quantifiable HIV-RNA, exploring as potential determinants some clinical and viroimmunological variables. Plasma samples from a national study in Italy, collected between 2003 and 2012, were used. According to plasma HIV-RNA levels, three groups were defined: full suppression (target not detected), low-level viremia (target detected but <37 copies/ml), and quantifiable HIV-RNA (≥37 copies/ml). Multivariable logistic regression was used to define determinants of full viral suppression and of quantifiable HIV-RNA. Among 107 women evaluated at a median gestational age of 35 weeks, 90 (84.1%) had HIV-RNA <37 copies/ml. Most of them (59/90, 65.6%) had full suppression, with the remaining (31/90, 34.4%) showing low-level viremia (median: 11.9 copies/ml; IQR 7.4-16.3). Among the 17 women with quantifiable viral load, median HIV-RNA was 109 copies/ml (IQR 46-251), with only one case showing resistance (mutation M184V; rate: 9.1%). In multivariable analyses, women with higher baseline HIV-RNA levels and with hepatitis C virus (HCV) coinfection were significantly more likely to have quantifiable HIV-RNA in late pregnancy. Full viral suppression was significantly more likely with nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and significantly less likely with higher HIV-RNA in early pregnancy. No cases of HIV transmission occurred. In conclusion, HIV-infected pregnant women showed a high rate of viral suppression and a low resistance rate before delivery. In most cases no target HIV-RNA was detected in plasma, suggesting a low risk of subsequent virological rebound and development of resistance. Women with high levels of HIV-RNA in early pregnancy and those who have concomitant HCV infection should be considered at higher risk of having quantifiable HIV-RNA at the end of pregnancy.

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“…20 The study received ethics committees approval, and each patient provided written informed consent. Pregnancy monitoring included at least one clinical and laboratory evaluation per trimester.…”

Section: Materials and Methods Populationmentioning

confidence: 99%

Common occurrence of anaemia at the end of pregnancy following exposure to zidovudine-free regimens

Pinnetti

Baroncelli

Molinari

et al. 2011

Journal of Infection

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Diagnosis of HIV infection in pregnancy: data from a national cohort of pregnant women with HIV in Italy

Cited by 40 publications

References 13 publications

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Full Viral Suppression, Low-Level Viremia, and Quantifiable Plasma HIV-RNA at the End of Pregnancy in HIV-Infected Women on Antiretroviral Treatment

Common occurrence of anaemia at the end of pregnancy following exposure to zidovudine-free regimens

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