Abstract
BackgroundIn the Highly Active Antiretroviral Therapy (HAART) era, the prognosis of children perinatally infected with HIV-1 has significantly improved, so the number of perinatally-infected females entering child-bearing age and experiencing motherhood is increasing.MethodsA description of the medical history and pregnancy outcomes of women with perinatal acquired HIV-1 infection enrolled in the Italian Register for HIV infection in Children.ResultsTwenty-three women had 29 pregnancies. They had started an antiretroviral therapy at a median of 7.7 years (interquartile range, IQR 2.3 - 11.4), and had experienced a median of 4 therapeutic regimens (IQR 2–6). Twenty women (87%) had taken zidovudine (AZT) before pregnancy, in 14 cases as a starting monotherapy. In 21 pregnancies a protease inhibitor-based regimen was used. At delivery, the median of CD4+ T lymphocytes was 450/μL (IQR 275–522), and no viral load was detectable in 15 cases (reported in 21 pregnancies). Twenty-eight children were delivered through caesarean section (median gestational age: 38 weeks, IQR 36–38, median birth weight: 2550 grams, IQR 2270 – 3000). Intravenous AZT was administered during delivery in 26 cases. All children received oral AZT (median: 42 days, IQR 31 – 42), with no adverse events reported. No child acquired HIV-1 infection.ConclusionsDespite a long history of maternal infection, multiple antiretroviral regimens and, perhaps, the development of drug-resistant viruses, the risk of mother-to-child transmission does not seem to have increased among the second-generation of HIV-1 exposed infants.
Highlights
In the Highly Active Antiretroviral Therapy (HAART) era, the prognosis of children perinatally infected with HIV-1 has significantly improved, so the number of perinatally-infected females entering child-bearing age and experiencing motherhood is increasing
An increasing number of these children are entering adolescence and young adulthood, with a consequent proportion of females becoming sexually active and pregnant. These mothers presented with a long history of HIV-1 infection and sometimes AIDS complications
We describe the clinical aspects of pregnancy in women with perinatally acquired HIV-1 infection enrolled over the years in the Italian Register for HIV Infection in Children
Summary
In the Highly Active Antiretroviral Therapy (HAART) era, the prognosis of children perinatally infected with HIV-1 has significantly improved, so the number of perinatally-infected females entering child-bearing age and experiencing motherhood is increasing. The introduction of Highly Active Antiretroviral Therapy (HAART) has significantly improved the quality of life and prognosis of children with perinatally acquired HIV-1 infection in resource-rich countries [1,2]. An increasing number of these children are entering adolescence and young adulthood, with a consequent proportion of females becoming sexually active and pregnant. These mothers presented with a long history of HIV-1 infection and sometimes AIDS complications. Reports from Europe [3,4], Puerto Rico [5], India [6], USA [7,8,9,10], and Brazil [11] describe favourable maternal and neonatal outcomes, with a MTCT rate varying from 0 to 7.7%, detected in cases of poor adherence to therapy [10].
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