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

Prieto, Luís; McPhee, Carolina Fernández; Rojas, Patricia; Mazariegos, Diana; Muñoz, Eloy; Mellado, María José; Holguín, África; Navarro, Marı́a Luisa; González-Tomé, María Isabel; Ramos, José Tomás

doi:10.1371/journal.pone.0183558

Cited by 13 publications

(10 citation statements)

References 32 publications

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“…As observed in previous series, [4][5][6][7][8][9][10][15][16][17] a high percentage of the women were not virologically suppressed when they become pregnant, despite having access to medical care and being engaged in intensive health care programs since childhood. In the mentioned cohorts, the rate of viral suppression at delivery ranged from 41% to 85.7%, and in most cases, it was below 70%.…”

Section: Discussionsupporting

confidence: 72%

Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain

López

Prieto-Tato

Escosa-García

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this population frequently exposed to numerous antiretroviral regimens. This study describes the long-term outcomes of pregnant women living with perinatally acquired HIV in Spain.Methods: Descriptive, retrospective, multicenter study of the women living with perinatally acquired HIV who gave birth between January 2000 and December 2019 in Madrid. Epidemiological, clinical, and HIV-related data were collected from the first delivery to the end of the study period, including antiretroviral therapy, prevention strategies, and outcomes.Results: Sixty-three live births in 33 women were included. The mean number of pregnancies per women was 1.9 (range: 1-6). At first delivery, women's median age was 20 years (interquartile range: 18-23), 11 (33.3%) had been previously diagnosed with AIDS and 6 (18%) with mental health disorders. Forty percent became pregnant unsuppressed, whereas 81% achieved viral suppression at delivery. Treatment interruptions were common after delivery, as were losses to follow-up, with no positive effect of pregnancy on retention to care or the immune virological situation. Five women (15%) experienced a new AIDS event, and there were 2 deaths (6%) during follow-up. There was 1 case of mother-to-child transmission in a nonadherent woman in whom preventive measures could not be implemented.Conclusions: Pregnancy in this unique population of women living with perinatally acquired HIV poses particular challenges. Specific strategies, including a multidisciplinary approach, are needed to minimize perinatal transmission risks and improve outcomes during the postpartum period.

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Section: Discussionsupporting

confidence: 72%

Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain

López

Prieto-Tato

Escosa-García

et al. 2022

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…28,29 These differences in baseline CD4 count may be attributable to suboptimal ART regimens, drug resistance, and/or suboptimal adherence due to psychosocial factors. 30 Black women were less likely to have viral suppression compared to non-black women. This may be related to delayed ARV initiation 31 or other contributing structural factors such as lack of access to HIV care and less social support.…”

Section: Discussionmentioning

confidence: 89%

“…Refer to Web version on PubMed Central for supplementary material. (37,30,7), STIs (35,21,6), mode of HIV acquisition (18,18,3).…”

Section: Supplementary Materialsmentioning

confidence: 99%

Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth

O’Brien

Williams

Huo

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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BACKGROUND-Birth rates among women living with HIV (WLHIV) have increased recently, with many experiencing multiple pregnancies. Yet, viral suppression is often not sustained between pregnancies. Additionally, protease inhibitors (PIs) have been associated with preterm birth, but associations between integrase strand transfer inhibitors (INSTIs) and preterm birth are less well characterized.METHODS-We studied WLHIV with ≥2 liveborn infants enrolled into the Pediatric HIV/AIDS Cohort Study (PHACS) Surveillance Monitoring for ART Toxicities (SMARTT) study between 2007-2018, comparing CD4 counts and viral loads (VLs) between two consecutive SMARTT pregnancies. We evaluated associations of covariates with CD4 and viral suppression, and the association of PI/INSTI use during pregnancy with odds of preterm birth.RESULTS-There were 736 women who had ≥2 liveborn children enrolled in SMARTT (1695 pregnancies). Median CD4 counts remained stable over repeat pregnancies. While > 80% of women achieved VL suppression during pregnancy, more than half had detectable VL early in their subsequent pregnancy. In adjusted models including all singleton pregnancies, an increased odds of preterm birth was observed for women with 1 st trimester PI initiation (adjusted odds ratio [OR] 1.97; 95% CI 1.27, 3.07) compared to those not receiving PIs during pregnancy, and for 1 st trimester INSTI initiation (adjusted OR 2.39; 95% CI 1.04, 5.46) compared to those never using INSTIs during pregnancy. CONCLUSIONS-MostWLHIV achieved VL suppression by late pregnancy but many were viremic early in subsequent pregnancies. First trimester initiation of PIs or INSTIs was associated with higher risk of preterm birth.

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“…In a study of 28 pregnant women, nine of them (32%) were at high risk of perinatal transmission because of a detectable viral load close to delivery. In this series, there was no transmission of HIV infection in the second generation thanks to the implementation of retention in care strategies and optimisation of ART [ 65 ].…”

Section: What Happened To Children Born With Hiv?mentioning

confidence: 99%

Past and future of HIV infection. A document based on expert opinion

Bouza¹

2022

Rev Esp Quimioter

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HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflection.

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

Cited by 13 publications

References 32 publications

Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain

Pregnancy Outcomes Among Perinatally HIV-Infected Women in Spain

Repeat Pregnancies Among US Women Living With HIV in the SMARTT Study: Temporal Changes in HIV Disease Status and Predictors of Preterm Birth

Past and future of HIV infection. A document based on expert opinion

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