Prevention of mother‐to‐child transmission of HIV in Latvia, 2008–2011

Abstract

Purpose of the study The aim of this study was to describe trends in the management of pregnancies in HIV‐infected women and their outcomes, over a 4‐year period in Latvia on an Infectology Center of Latvia (LIC) basis. Methods The study of HIV‐infected women in Latvia giving birth to one or more children between 1 Jan 2008 and 31 Dec 2011. Results We identified 199 HIV‐infected women with 210 pregnancies. Mean age was 27 years, median baseline pregnancy CD4 count was 452 cells/mm3, the baseline pregnancy plasma viral load (VL) was 53,066 copies/ml. Knowledge of HIV status before pregnancy was 60.5%, but 32.5% HIV‐positive diagnosis was confirmed during pregnancy and 7.1% after delivery. One pregnant woman's HIV disease progressed to AIDS and death. Women on antiretroviral therapy (ART) were 82.3%. Maternal monotherapy with the zidovudine (ZDV) rate was 10.4%, dual therapy with nucleoside reverse‐transcriptase inhibitor (NRTI) ‐ 2.3%, triple therapy with the protease‐inhibitor (PI) plus NRTI ‐ 87.3%. Median VL at delivery was 1349. A greater proportion of cases 91.5% had a VL <1000 copies/ml, from them 47.4% <40 copies/ml. Vaginal deliveries range was 20.8% of pregnancies and elective cesarean delivery 68.6%. Preterm delivery occurred in 12.1%. Overall mother‐to‐child transmission (MTCT) of HIV rate was 4.3%. Among the 35.5% of mothers initiating ART at 14 weeks’ gestation, MTCT was 1.4%, compared with 1.5% and 3.1% for those initiating ART at <14 weeks (n=67, 31.9%) and >24 weeks (n=32, 15.2%). Among 17.6% women, who did not receive prophylactic ART, MTCT rate was 16.2%. 7 of 9 women giving birth to an HIV‐positive child were diagnosed with HIV before pregnancy, 1 of 9 during pregnancy, 1 of 9 after delivery. From women giving birth to an HIV‐positive child 6 did not receive prophylactic ART, 1 started ART at week 14, 2 after week 14. Conclusions Women's low education, recurrent pregnancies, intravenous drug use, vaginal deliveries, not receiving and late initiation of prophylactic ART was independently (p<0.05) associated with an increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV‐ infected women (also HIV status identification twice during pregnancy). Management of pregnancies in HIV‐infected women according to the LIC guidelines, i.e. ART from week 14, intravenous ZDV during labour, elective cesarean delivery, neonatal ZDV during 6 weeks and no breastfeeding is effective to reduce risk for MTCT.