Adverse outcomes of pregnancy in HIV-positive women in the era of HAART: a perspective from an outer London centre in the UK

Abstract

Background : Increasing number of women with HIV are choosing to become pregnant as there is dramatic reduction in the risk of vertical transmission. However, management of HIV in pregnancy still poses a variety of challenges and adverse pregnancy outcomes are still common. We aimed to explore the factors associated with adverse outcomes of pregnancy in our HIV cohort. Methods : It is a retrospective case note review of all the women attended our unit and had HIV care from 2008-2011. A total of 87 women were followed up. Three women had two pregnancies during the study period. Data collected from Genitourinary Medicine and maternity records were analysed using SPSS program. Results : Mean age was 34 yrs ranging from 20-43 yrs. Majority (91%) were of African origin; 67% had HIV subtype C; 26% resistant to one or more class of HIV drugs; 55% had a nadir CD4 fewer than 350; 44% diagnosed at an antenatal setting and 62% were planned pregnancies. Prior to the current pregnancy, these women had 121 children: 5% of the children have HIV and 33% not tested for HIV. Of the partners, 38% have HIV and 73% were aware of their partner's HIV status. None of the children born during the study period were infected with HIV; mean birth weight was 2789 g; there were 3 sets of twins; one still birth and one child died soon after birth. Around 46% were on anti-retroviral therapy (ART) during conception, 6% had miscarriages and 16% had emergency caesarean sections. At delivery, viral load was detectable in 23%, mainly due to poor adherence (11%) and late presentation (9%). 38% of the women experienced an obstetric complication, premature labour 9%; premature rupture of membranes and gestational diabetes both accounted to 4% whilst 3% had post-partum haemorrhage. On ART during conception and late HIV diagnosis that is nadir CD4, less than 350 cells were significantly associated (P< 0.05) with having a foetal complication such as prematurity 8%, low birth weight 7% or having a foetal abnormality 2.3%. There was no significant association between 1st and 2nd trimester ART exposure and adverse pregnancy outcomes such as prematurity, low birth weight or foetal abnormality. Conclusion : Late diagnosis of HIV and ART during conception is significantly associated with adverse outcomes of pregnancy. Widespread HIV testing is essential and has to be extended to non-traditional settings. In addition, more studies are needed on ART exposure and adverse pregnancy outcomes. (Published: 11 November 2012) Citation: Abstracts of the Eleventh International Congress on Drug Therapy in HIV Infection Thayaparan P et al. Journal of the International AIDS Society 2012, 15 (Suppl 4):18238 http://www.jiasociety.org/index.php/jias/article/view/18238 | http://dx.doi.org/10.7448/IAS.15.6.18238