Twenty Years of Improved Perinatal Outcomes for Pregnancies Affected by HIV Infection

Abstract

Background: Highly active antiretroviral therapy has emerged as an essential treatment component to prevent vertical transmission of Human Immunodeficiency Virus (HIV). Yet there often remain missed opportunities to prevent vertical HIV transmission. We present a case that illustrates obstetric management and outcome for involving 2 generations of congenital HIV transmission. Presentation of the Case: Patient is a 19-year-old primigravida with congenital HIV presented to Lincoln Medical and Mental Health Center’s for her initial prenatal care at 36 weeks of gestation. Upon documentation of a high viral load, the patient was given intravenous Azidothymidine and scheduled for Caesarean delivery. AZT and lamivudine were recommended and prescribed for the neonate who tested positive HIV test for which AZT and lamivudine were recommended and prescribed, but the mother discontinued AZT after discharge from the hospital. At 1 month of age the infant succumbed to sudden infant death syndrome (SIDS). During the 2nd pregnancy the patient received adequate prenatal care as well as antiretroviral therapy, Truvada, Abacavir, Mepron, and Kaletra throughout the antenatal course. After preoperative intravenous AZT, via a repeat cesarean the patient delivered a neonate whose HIV test was negative. The patient’s 2nd child had an uncomplicated neonatal course and was negative for HIV on 3 subsequent tests and remained HIV negative until this date. Antiretroviral were removed and the child has remained HIV negative. The mother died from pneumonia and respiratory failure secondary to HIV 2 years after the 2nd delivery. Conclusion: This case serves as a reminder of the importance of adhering to current clinical standards for the care of pregnancies affected by HIV infection.