Epidemiological and Clinical Features of Pregnant Women with HIV: A 21-Year Perspective from a Highly Specialized Regional Center in Southern Italy

Martinelli, Pasquale; Agangi, Annalisa; Sansone, Matilde; Maruotti, Giuseppe Maria; Buffolano, Wilma; Paladini, D.; Pizzuti, Renato; Floridia, Marco

doi:10.1310/hct0901-36

Cited by 8 publications

(12 citation statements)

References 10 publications

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“…The annual number of reported HIV pregnancies increased fivefold during the period, from seven in 1995 to 35 in 2007, peaking in 2006 with 39 pregnancies. This is in accordance with the findings in other studies describing a rise in HIV pregnancies over time and can partly be explained by changes in the management of HIV, with longer survival as a result of ART, and an increasing desire for maternity among HIV-infected women [11,12]. A change in recommendations given to HIV-infected women by health professionals also explains the increasing number of deliveries over time; before year 2000 pregnancies in HIV-infected women were not advisable and termination of pregnancy was proposed, but with the minimal risk of MTCT after initiation of ART, this recommendation was changed and women were encouraged to continue their pregnancy.…”

Section: Discussionsupporting

confidence: 92%

“…No women in this study treated according to the national guidelines transmitted HIV to her children. The low rate of MTCT in Denmark is comparable to that of other European cohorts [4,10,12,13].…”

Section: Discussionsupporting

confidence: 56%

“…Information about mode of HIV acquisition was available for 139 women, of whom 91%, delivering in 2000-2008, were infected heterosexually. A shift towards heterosexually acquired infections may also explain the rise in HIV pregnancies [11,12]. We only observed one pregnancy in a woman who acquired HIV vertically from her own mother.…”

Section: Discussionmentioning

confidence: 91%

“…Their mothers were not tested for HIV during pregnancy despite belonging to high-risk groups. In other Scandinavian countries, HIV screening is recommended for all pregnant women during the first trimester [24][25][26], and in Italy HIV testing is in addition provided for all women at a preconception visit and in the third trimester [12]. From January 2010, routine antenatal HIV testing will be implemented in Denmark and, although some women may seroconvert during pregnancy and some will refuse to take the test, this is expected to further reduce the MTCT of HIV in Denmark.…”

Section: Discussionmentioning

confidence: 99%

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Prevention of mother‐to‐child transmission of HIV in Denmark, 1994–2008

et al. 2010

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Objectives The aim of this study was to describe trends in the management of pregnancies in HIV‐infected women and their outcomes over a 14‐year period in Denmark on a national basis. Methods The study was a retrospective cohort study of all HIV‐infected women in Denmark giving birth to one or more children between 1 June 1994 and 30 June 2008. Results We identified 210 HIV‐infected women with 255 pregnancies, ranging from 7 per year in 1995 to 39 per year in 2006. Thirty per cent of the women were Caucasian and 51% were Black African. Knowledge of HIV status before pregnancy increased from 8% (four of 49) in 1994–1999 to 80% (164 of 206) in 2000–2008. Only 29% (53 of 183) of the women chose to consult an infectious disease specialist when planning pregnancy, while 14% (27 of 199) received assistance with fertility. The proportion of women on antiretroviral therapy (ART) increased from 76% (37 of 49) in 1994–1999 to 98% (201 of 206) in 2000–2008. Vaginal deliveries ranged from 0 in 2003 to 35% of pregnancies in 2007. Mother‐to‐child transmission (MTCT) of HIV decreased from 10.4% in 1994–1999 to 0.5% in 2000–2008. All women giving birth to an HIV‐positive child were diagnosed with HIV during or after delivery and did not receive prophylactic ART. Conclusions The annual number of HIV pregnancies increased fivefold during this 14‐year period and substantial changes in pregnancy management were seen. No woman treated according to the national guidelines, i.e. ART before week 22, intravenous zidovudine (ZDV) during labour, neonatal ZDV for 4 to 6 weeks and no breastfeeding, transmitted HIV to her child.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Prevention of mother‐to‐child transmission of HIV in Denmark, 1994–2008

et al. 2010

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“…Also Martinelli et al [53] reported few cases of preeclampsia in their epidemiological survey on HIV infection (only two cases among 159 HIV-positive women).…”

Section: Discussionmentioning

confidence: 99%

HIV Infection in Pregnancy and the Risk of Gestational Hypertension and Preeclampsia

Landi¹,

Bezzeccheri²,

Guerra³

et al. 2014

WJCD

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The objective of this study was to evaluate the association between HIV infection and hypertensive disorders of pregnancy, comparing the rates of preeclampsia and gestational hypertension in a HIV-infected pregnant group and in a HIV-negative control pregnant group matched for age and parity. Furthermore, we aimed to compare the rates of hypertensive disorders in a subgroup of HIV-positive and HIV-negative African-American Black women. Patients and Methods: This was a prospective observational cohort study conducted at two University Departments of Obstetrics and Gynecology, Salesi Hospital, Ancona, and Sant'Orsola Hospital, Bologna. The HIV-infected patients' group consisted of 126 pregnant women; 140 HIV-negative pregnant women matched for age and parity served as controls. Gestational hypertension and preeclampsia were diagnosed according to NHBPEP-ISSHP criteria. Categorical data were analyzed using the Fisher exact test. Statistical significance was set at a p value < 0.05. Results: Gestational hypertension and preeclampsia were diagnosed in 3 of 126 HIV-positive patients (2.38%) and in 14 of 140 HIV-negative patients (10%), with a relative risk of 0.24 (p = 0.0112). In the subgroup of African-American Black women, gestational hypertension and preeclampsia were diagnosed in 2 out of 43 HIV-positive (4.7%) and in 3 out of 18 HIV-negative patients (16.7%) with a relative risk of 0.28, not statistically significant (p = 0.1887). Conclusion: Pregnant women with HIV infection seem to be protected against gestational hypertension and preeclampsia and this protective effect remains also in a high risk population, such as African-American Black ethnic group. The effect is present independently from treatment received and virus copies. The lack of immune response present since the conception period should account for unopposed trophoblast invasion resulting in a better placentation. B. Landi et al. 258

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Gender difference in advanced HIV disease and late presentation according to European consensus definitions

Jiang

Yin

Fan

et al. 2015

Sci Rep

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Effectiveness of highly active antiretroviral therapy is limited for a large proportion of individuals living with HIV presenting for medical care at an advanced stage. Controversial results of gender differences in risk of late HIV diagnosis were reported among existing literatures. Therefore, we conducted this meta-analysis to synthesize a summary of gender differences in risk of advanced HIV disease (AHD) and late presentation (LP) according to European consensus definitions. Totally, 32 studies were included based on predetermined selection criteria. The pooled adjusted odds ratios of males presenting with AHD and LP compared with females were 1.73 (95% confidence interval [CI], 1.59–1.89) and 1.38 (95% CI, 1.18–1.62) with significant heterogeneity observed (I2 = 78.50%, and I2 = 85.60%, respectively). Subgroup analysis revealed that time lag, study location, number of patients, proportion of females, study design, number of adjusted variables might be potential source of heterogeneity. Sensitivity analysis showed robustness of the results. No publication bias was observed in studies on AHD or LP. The current meta-analysis indicated that males are at higher risk of AHD or LP compared with females. More attention should be paid to males to make sure early testing, diagnosis, and treatment, and ultimately improve individual and population health.

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Epidemiological and Clinical Features of Pregnant Women with HIV: A 21-Year Perspective from a Highly Specialized Regional Center in Southern Italy

Cited by 8 publications

References 10 publications

Prevention of mother‐to‐child transmission of HIV in Denmark, 1994–2008

Prevention of mother‐to‐child transmission of HIV in Denmark, 1994–2008

HIV Infection in Pregnancy and the Risk of Gestational Hypertension and Preeclampsia

Gender difference in advanced HIV disease and late presentation according to European consensus definitions

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