[TuOa0301] HIV-INFECTED PREGNANT WOMEN AND MOTHER-TO-CHILD TRANSMISSION IN EUROPE: CHARACTERISTICS OF THE EPIDEMICS IN WESTERN, CENTRAL AND EASTERN EUROPE

3rd International AIDS Society Conference on HIV Pathogenesis and Treatment

Rio de Janeiro - July 24 - 27, 2005

HIV-INFECTED PREGNANT WOMEN AND MOTHER-TO-CHILD TRANSMISSION IN EUROPE: CHARACTERISTICS OF THE EPIDEMICS IN WESTERN, CENTRAL AND EASTERN EUROPE

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. TuOa0301

Thorne C.¹, Patel D.¹, Malyuta R.², Semenenko I.², Newell M.-L.¹, European Collaborative Study T.¹
¹ Institute of Child Health, University College London, London, United Kingdom, ² Odessa Oblast Maternity Hospital, Odessa, Ukraine

INTRODUCTION: In Western Europe, widespread use of effective interventions to prevent mother-to-child transmission of HIV (MTCT) has resulted in very low MTCT rates. However, in Eastern Europe there is a substantially higher prevalence of HIV infection, more women of childbearing age affected and health care systems with limited capacity and resources to cope with the worsening HIV epidemic.

METHODS: In the European Collaborative Study (ECS), HIV-infected pregnant women and their infants are followed up prospectively. The ECS includes centres from Spain, Italy, UK, Germany, Belgium, Sweden (since 1985), Netherlands (1987), Poland (1989), Denmark (1995) and Ukraine (2000). Data on 5967 mother-child pairs enrolled by December 2004 were analysed (4537 from Western, 179 from Central and 1251 from Eastern Europe).

RESULTS: In 1985, 88% of women enrolling in the West had a history of injecting drug use (IDU), but by 2004, 75% had heterosexual acquisition. IDU predominated in Central Europe, while in Eastern Europe IDU gradually declined from 32% in 2000 to 27% in 2004. Overall MTCT rates were 1.59% (95% CI 0.96-2.47) and 6.69% (95% CI 4.86-8.93) in West/Central and Eastern Europe respectively in 2000-2004. Adjusting for maternal CD4 count, gender and prematurity, antenatal HAART was associated with a 75% reduced MTCT risk versus monotherapy (AOR 0.25, 95% CI 0.12-0.55) and elective caesarean section (CS) with a 66% reduction versus vaginal delivery (AOR 0.34, 95% CI 0.22-0.52) in Western/Central Europe. In Eastern Europe, use of SD NVP and/or short-course ZDV was associated with a 70% reduction in MTCT risk (AOR 0.30, 95% CI 0.14-0.64).

CONCLUSIONS: There is substantial sub-regional variation in the HIV epidemic among pregnant women across Europe. MTCT rates in Western/Central Europe are now extremely low, while in Eastern Europe, rates are somewhat higher due to the use of less effective MTCT prophylaxis and fewer elective CS deliveries.

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Prevention | TuOa0301 | Claire Thorne
Epidemiology of vertical transmission

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