15th Annual Conference of the British HIV Association 1-3 April 2009, Liverpool, UK

PREGNANCIES IN HIV-INFECTED ADOLESCENTS: A MULTICENTRE DESCRIPTIVE STUDY

HIV Med 2009 Apr 1-3 (Suppl 1);15:8 (abstract no. O11)

A Elgalib¹, A Samarawickrama², S Roedling³, S Tariq⁴, E Draeger⁵, A Hegazi⁶, T Rathnayaka⁷, A Azwa⁹, D Hawkins⁹, M Rodgers⁶, R Shah¹⁰, S Edwards³, J Russell⁸, H Noble⁵, M Poulton², J Anderson⁴, G Taylor⁷ and A de Ruiter^1
1Guy’s & St Thomas’ NHS Foundation Trust, London, UK, ²King’s College Hospital NHS Foundation Trust, London, UK, ³UCL Centre for Sexual Health & HIV Research, Mortimer Market Centre, London, UK, ⁴Homerton University Hospital NHS Foundation Trust, London, UK, ⁵Newham University Hospital NHS Trust, London, UK, ⁶Mayday University Hospital, London, UK, ⁷Imperial College School of Medicine at St. Mary’s Hospital, London, UK, ⁸Queen Elizabeth Hospital NHS Trust, London, UK, ⁹Chelsea and Westminster NHS Foundation Trust, London, UK, ¹⁰Barnet General Hospital, London, UK

BACKGROUND: In the UK adolescent girls are at high risk for sexually transmitted infections (STI) and unplanned pregnancies. Numbers of HIV-infected adolescents are expected to rise.

METHODS: A retrospective case note review of HIV-infected pregnant teenagers aged 13–19 years between 2000 and 2007 from 10 clinical centres.

RESULTS: Fifty-nine pregnancies in 52 women. 64% were Black African and 14% Black Caribbean. One acquired HIV vertically. Median ages at HIV diagnosis and conception were 17 and 18 years, respectively. 36% were diagnosed pre-conception. Median gestational age (GA) at diagnosis was 18 weeks (W) in cases diagnosed antenatally. 56% were primigravidae. 86% of pregnancies were unplanned. 39% used no contraception; 19% used condoms. Contraception use was not documented in 42%. In 67% of known HIV-infected, contraception was discussed in 12 months preceding pregnancy. 29% had an STI screen within 6 months of conception. Median CD4 count at conception was 379. Four were on antiretroviral treatment (ART) at conception; 55 started ART whilst pregnant, with 78% to prevent mother-to-child transmission only. Median GA at starting ART was 28 W. 53% reported excellent ART adherence. 68% of those on HAART had undetectable HIV viral load at delivery. Median GA at delivery was 38 W. 26% had preterm delivery. Mode of delivery was Caesarean section and vaginal delivery in 58% and 41%, respectively. 85% were uncomplicated pregnancies. There were 59 live births. 1 baby was HIV-infected. During 12 months post-delivery, 22% became pregnant and 51% had contraception advice documented.

CONCLUSIONS: Although most pregnancies were unplanned, obstetric and virological outcomes were favourable. Documentation of contraception use and advice was poor. Nearly a quarter conceived again within 12 months of delivery. Although at high risk for STI, only a third were screened for STI within 6 months of conception. Effective measures to reduce HIV and STI transmission and unplanned pregnancies in HIV-infected adolescents are needed.

2009-04-01
O11

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