Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002–2009

Abstract

ObjectiveTo describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts. MethodsA prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling. ResultsAntiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P<0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P<0.001). The proportion of women with viral loads below 1000copies/mL at hospital discharge after delivery (HD) increased over time (P=0.0031). Median CD4 lymphocyte counts also rose at HD, from 441cell/mm3 to 515cells/mm3 (P<0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P=0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%). ConclusionThe results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region.