Abstract
AimsTo compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs.Design and settingProspective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000–10.ParticipantsPregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum.MeasurementsMaternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW).FindingsOf 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non-IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non-IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non-IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non-IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non-IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non-IDUs (58% versus 68%, P = 0.03).ConclusionsPregnant human immunodeficiency virus-infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women.
Highlights
Injecting drug use (IDU) accounts for one in three new human immunodeficiency virus (HIV) infections outside subSaharan Africa [1], and drives the escalating HIV epidemic in eastern Europe and Central Asia (EE&CA)
Little is known about access of IDUs to prevention of mother-to-child transmission (MTCT) (PMTCT) services or their pregnancy outcomes, including MTCT, in this setting, limited data from western Europe and the Russian Federation have demonstrated HIV-infected IDUs to be at increased risk of non-receipt of PMTCT prophylaxis [25,26,27] and antenatal care [19]
Women were defined as ‘current IDUs’ if IDU was reported during the current pregnancy and/or if their infant had neonatal abstinence syndrome (NAS), but we considered all women with an IDU history to be IDUs in recognition that IDU can be a chronic and relapsing condition [31]
Summary
Injecting drug use (IDU) accounts for one in three new human immunodeficiency virus (HIV) infections outside subSaharan Africa [1], and drives the escalating HIV epidemic in eastern Europe and Central Asia (EE&CA). Low uptake of health services, including antenatal care (ANC), is a well-recognized problem among female IDUs [17,18], including those with HIV [19]. Little is known about access of IDUs to prevention of MTCT (PMTCT) services or their pregnancy outcomes, including MTCT, in this setting, limited data from western Europe and the Russian Federation have demonstrated HIV-infected IDUs to be at increased risk of non-receipt of PMTCT prophylaxis [25,26,27] and antenatal care [19]. Our aim was to compare clinical status, MTCT rates and risks, use of PMTCT interventions and pregnancy outcomes between HIV-infected IDUs and non-IDUs participating in a prospective cohort study of pregnant HIV-infected women and their children in Ukraine
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