Pregnancy outcomes in young mothers with perinatally and behaviorally acquired HIV infections in Rio de Janeiro

ABSTRACT Background: Perinatally HIV-infected children are surviving into adulthood, and getting pregnant. There is a scarcity of information on health and pregnancy outcomes in these women. Aim: To evaluate characteristics related to HIV disease and pregnancy outcomes in perinatally infected women, and to compare these women with a group of youth with behaviorally acquired HIV-infection, at a reference hospital in Rio de Janeiro, Brazil. Methods: A cohort study. Epidemiological, clinical, and laboratory data were compared between perinatally (PHIV) and behaviorally HIV-infected (BHIV) pregnant youth with the primary aim to study pregnancy outcomes in the PHIV group and compare with outcomes to BHIV group. Results: Thirty-two pregnancies occurred in PHIV group, and 595 in BHIV group. A total of seven (22%) PHIV women and 64 (11%) BHIV women had a premature delivery (p = 0.04), however, when adjusting for younger age at pregnancy, and antiretroviral therapy initiation in 1st trimester of pregnancy (OR = 18.66, 95%CI = 5.52-63.14), the difference was no longer significant. No cases of mother-to-child HIV transmission (MTCT) were observed in the PHIV group while there was a 2% MTCT rate in BHIV group. Conclusion: Pregnancy among PHIV was as safe as among BHIV. The differences between those groups were probably related to treatment and prolonged care in the first group.

Antiretroviral treatment, viral load of mothers & perinatal HIV transmission in Mumbai, India.

Background & objectives: Mother-to-child transmission (MTCT) is the most significant route of HIV transmission in children below the age of 15 yr. In India, perinatal HIV transmission, even after treatment, accounts for 5.4 per cent of HIV cases. The present study was conducted to evaluate the efficacy of anti-retro viral therapy (ART) or prophylactic treatment (PT) to control maternal viral load in HIV positive women, and its effect on vertical HIV transmission to their infants. Methods: A total of 58 HIV positive women were enrolled at the time of delivery and their plasma samples were obtained within 24 h of delivery for estimation of viral load. Viral load analysis was completed in 38 women. Infants received single dose nevirapine within 2 h of birth and zidovudine for 6 wk. At the end of 18 month follow up, HIV positive or negative status was available in 28 infants. Results: Results revealed undetectable levels of viral load in 58.3 per cent of women with ART compared to 30.7 per cent of women with PT. No women on ART had viral load more than 10,000 copies/ml, whereas seven (26.9%, P=0.07) women receiving PT had this viral load. Median CD4 count of women on PT (483 cells/μl) was high compared to the women on ART (289 cells/ μl). At the end of 18 months follow up, only two children were HIV positive, whose mothers were on PT. One had in utero transmission; infection detected within 48 h of delivery, while the other child was infected post partum as HIV was detected at six months follow up. Interpretation & conclusions: Women who received a single dose of nevirapine during delivery had higher levels of viral load than women on ART. Combination drug therapy for pregnant women is now a standard of care in most of the western countries; use of nevirapine monotherapy at the time of delivery in our settings is not effective in controlling viral load. This highlights initiation of ART in pregnant women to control their viral load and thus to inhibit mother to child HIV transmission.

Diagnosis of Perinatal Transmission of HIV-1 Infection by HIV DNA PCR

To determine the sensitivity and specificity of HIV DNA PCR (Qualitative) at various age groups to detect or rule out HIV infection in infants born to HIV infected mothers. Pediatric and perinatal HIV clinic in a tertiary pediatric hospital.Sixteen infants born to HIV positive mother enrolled in the prevention of mother to child transmission of HIV at our center were tested for HIV infection by HIV DNA PCR at 1.5 months, 3 months, 5.5 months and/or 7 months of age. Their HIV status was confirmed by an HIV ELISA test at 18 months of age by 2 different ELISA kits. Eight patients (50%) had a negative HIV DNA PCR whereas 8 patients (50%) had a positive DNA PCR of which 6 patients (75%) had a false positive HIV DNA PCR and no false negative DNA PCR. Thus, the sensitivity of HIV DNA PCR was 100% and specificity was 57.1% with a total efficiency of the test being 62.5%. The efficiency of HIV DNA PCR at 1.5 months of age was 50%, at 3 months of age 42.9%, at 5.5 months of age 60% and at 7 months of age was 100%. HIV DNA PCR has a high sensitivity but low specificity to diagnose HIV infection in infants less than 7 months of age. Hence, the results of the test have to be interpreted with caution in infants born to HIV positive mothers.