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8th Annual Conference Of The British HIV Association [BHIVA]19 – 21 April 2002, University of York, York |
[AUTHOR(S):] F Lyons, S Hopkins, K Butler, C Bergin, K Butler, F Mulcahy
GUIDE Clinic, St James's Hospital, Dublin, Ireland
BHIVA Conf 2002 Apr 19-21;8:O16
BACKGROUND: Late diagnosis of maternal HIV-1 in pregnancy presents multiple challenges. This clinic has witnessed a dramatic rise in the numbers of pregnant women presenting, particularly late in pregnancy. The mean gestation at diagnosis from January to December 2001 was 26 weeks. A protocol for managing late presenters is presented.
METHODS: Since 1998 a database of HIV-1 infected pregnant women has been maintained. Classification is according to time of diagnosis 'pre-conception', 'early' ≤28/40 weeks, 'late' ≤28–36/40, 'very late' ≥36/40, 'in labour', 'postnatal' and 'refuses therapy'. Group, virological and immunological markers determine specific management.
RESULTS: Of 180 deliveries between January 1998–December 2001, there have been two transmissions, with all other infants having at least one negative HIV polymerase chain reaction (PCR) test at ≥3 months of age. From January to December 2001 there were 51 pregnancies, 19 (37%) in women previously known to be HIV-1 infected and 32 (63%) diagnosed antenatally. Of the 32 diagnosed antenatally, 15 (47%) were diagnosed early, eight (25%) were diagnosed late and nine (28%) were diagnosed very late. All women with a CD4 count of ≤300 cells/μL are commenced on three-drug antiretroviral therapy regardless of gestational age (after the first trimester) and viral load. The management of women with CD4 count of >300 cells/μL, presenting at >28/40 weeks, will be outlined. All women are offered intrapartum/peri-operative intravenous zidovudine as per paediatric AIDS Clinical Trials Group (PACTG) 076. All infants receive antiretroviral therapy for 4 weeks post partum. All antiretroviral therapy is started as soon as possible in the various eligible groups. All women are advised not to breast-feed.
CONCLUSIONS: Effective management of HIV-1 infection diagnosed late in pregnancy requires detailed guidelines based on different scenarios.
PRESENTING AUTHOR: F Lyons
020419
O16
Copyright © 2002 - British HIV Association (BHIVA) Reproduction of this abstract (other than one copy for personal reference) must be cleared through the BHIVA Organising Secretariat 1 Mountview Court, 310 Friern Barnet Lane, London N20 0LD