Amniocentesis in Pregnant HIV-Infected Patients

Abstract

Before 2003, diagnostic amniocentesis and other invasive procedures were not performed in most eligible pregnant HIV-infected patients because of concern over the risk of mother-to-fetus transmission of the virus. With the introduction and widespread use of antiretroviral therapy (especially HAART), the resulting marked decline in the overall vertical transmission rate in HIV-infected pregnancies led to reappraisal of the actual risk of amniocentesis in a clinical setting. This single center retrospective study evaluated the risk of vertical transmission in 18,191 pregnant women seen at an antenatal clinic from 2001 to 2006. A total of 1168 amniocenteses were performed. Among the 18,191 deliveries during the study period, 330 were by mothers (1.8%) infected with HIV who gave birth to 318 live-born babies. There had been an indication for diagnostic amniocentesis in 34 (10.4%) of the HIV-infected mothers. Amniocentesis was performed in 11 (32.4%) of the eligible women and withheld in 23 (67.6%). Nine of the 11 delivered by mothers who had an amniocentesis were live-born. Demographic profiles and indications for amniocentesis were similar in the 2 groups. During pregnancy and the intrapartum period, all amniocentesis patients had been treated with highly active antiretroviral combination therapy (HAART) with 3 drugs. None of the live-born babies of HIV-infected mothers who underwent amniocentesis were infected with HIV. Among the 19 live-born babies of HIV-infected mothers who did not have an amniocentesis, 1 (5.3%) was positive for HIV. No significant differences were found in vertical transmission rates between the babies live-born to HIV-infected pregnant women with and without an indication for amniocentesis [1/28 (3.6%) vs. 8/290 (2.8%), respectively; P = 0.80]. There was also no difference in transmission rates between patients who had an amniocentesis and those in whom an amniocentesis was considered but withheld [0/9 vs. 1/19 (5.3%); P = 0.48]. The investigators believe that these findings, together with data from previous studies, suggest that diagnostic amniocentesis should not be systematically withheld on the basis of HIV infection.