AEGiS-13IAC: Antiretroviral therapy and caesarean section to reduce vertical transmission of HIV in Europe.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Antiretroviral therapy and caesarean section to reduce vertical transmission of HIV in Europe.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC240)

Thorne C; C. Thorne, Institute of Child Health, 30 Guilford Street, London WC1N 1EH, United Kingdom, Tel.: +44 207 905 21 05, Fax: +44 207 813 81 45, E-mail: c.thorne@ich.ucl.ac.uk

BACKGROUND: It is unclear how the vertical transmission (VT) rate in Europe will be affected by the combination of the changing characteristics of HIV-infected women becoming pregnant and the extent of interventions to reduce VT, as these could have opposing effects on mother-to-child transmission.

METHODS: Analysis of data on 2633 pregnant HIV-infected women and their 2820 infants enrolled and prospectively followed in the European Collaborative Study (ECS) between 1985 and December 1999. Factors examined include maternal characteristics, antiretroviral therapy and pregnancy outcome.

RESULTS: Heterosexual acquisition of infection has increased in the ECS, with injecting drug use becoming less important. The proportion of mother-child pairs receiving one or more components of the 076 regimen significantly increased from 64% in 1995 to 92% in 1998/9. Whereas in 1994 all these women received monotherapy, by 1998/9 24% received double therapy and 41% triple or quadruple therapy. A growing number of women became pregnant while on ART (12% in 1998/9); these women had been on ART for an average of 25 months before pregnancy. ART exposure in utero was not associated with prevalence or pattern of congenital abnormalities (p = 0.44), but was associated with moderate to severe anaemia in the infant (p > 0.05). By 1999, the overall elective Caesarean section rate had reached 66%, but there remain marked national differences. The overall rate of VT was 7% in 1998/9 compared with 16% before 1994.

CONCLUSIONS: This information highlights the impact that changes in treatment of adult HIV disease may have on obstetric management of infected women. Pregnant women and their care-givers may face dilemmas regarding therapy during pregnancy, given that little is known about the medium to long-term impact of ART exposure on uninfected children. Furthermore, despite therapeutic and surgical interventions, vertical transmission still occurs.

Keywords: AEGIS, Disease Transmission, Vertical, HIV Infections, Cesarean Section, HIV Seropositivity, Antiretroviral Therapy, Highly Active, Europe, Delivery, Obstetric, Pregnancy Outcome, Human, Female, Pregnancy, Adult, Child, Infant, therapy, transmission, surgery, drug therapy
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MoOrC240