Introduction Prevalence of pregnancy in women with perinatally acquired HIV infection (PAH-W) has markedly increased. HIV infection is related to preterm delivery, small for gestational age fetus (SGA), and pre-eclampsia (PE). PAH-W have higher incidence of longer periods of HIV-infection, lower levels of CD4 cells, and higher viral loads (VL). Available data are inconclusive about PAH-W related risks on pregnancy. The present study aims to analyse obstetric and perinatal outcomes in PAH-W.
Methods Retrospective cohort study involving pregnant PAH-W followed from 2005 to 2015. Results were compared to those obtained from pregnant women with sexually transmitted HIV-infection (STH-W). Antiretroviral therapy (ART), vertical transmission rate, obstetric and perinatal outcomes were considered. Chi-square, Fish extract, Mann-Whitney-Wilcoxon, and Student’s T tests were applied to non-continuous and continuous samples.
Results PAH-W group consisted of 14 patients and STH-W group had 17 women. PAH-W were younger (20.1±3.0 vs. 29.9±7.7 years, p=0.001) than STH-W. Nevertheless, groups were similar regarding to CD4 counts (471.7±271 vs. 302.7±183.5 cells/mm3, p=0.21), proportion of undetectable 34th-week VL (41.7% amongst the case group vs. 66.7%, p=0.26), and to the 34th-week VL levels (2.9±0.8 vs. 2.7±0.9 log, p=0,68). Prevalence of SGA (3 in PAH-W group vs. 1 in STH-W, p=0.28) and preterm labour (0 in PAH-W group vs. 2 in control group, p=0.49) were also similar in both groups. Neither cases of PE and spontaneous preterm delivery nor HIV-infected infant were found.
Conclusion PAH-W and STH-W had similar obstetric and perinatal results. Since both groups were comparable in CD4 counts and 34th-week VL levels, it is possible the occurrence of negative obstetric outcomes may be more likely related to the severity of HIV infection than to the mechanism of infection itself. Larger studies are still necessary to determine the role of PAH-W in pregnancy. However PAH-W should be emphasised on adequate ART and achieving low VL levels in order to reduce their obstetric and perinatal risks.
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