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Missed opportunities among HIV-positive women to control viral replication during pregnancy and to have a vaginal delivery

Aebi-Popp, Karoline and Mulcahy, Fiona and Glass, Tracy R. and Rudin, Christoph and Martinez de Tejada, Begona and Bertisch, Barbara and Fehr, Jan and Grawe, Claudia and Scheibner, Kathrin and Rickenbach, Martin and Hoesli, Irene and Thorne, Claire and the Swiss Mother, and Child HIV Cohort Study, . (2013) Missed opportunities among HIV-positive women to control viral replication during pregnancy and to have a vaginal delivery. Journal of acquired immune deficiency syndromes, Vol. 64, H. 1. S. 58-65.

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Official URL: http://edoc.unibas.ch/dok/A6165313

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Abstract

Most national guidelines for the prevention of mother-to-child transmission of HIV in Europe updated between 2001 and 2010 recommend vaginal deliveries for women with undetectable or very low viral load (VL). Our aim was to explore the impact of these new guidelines on the rates of vaginal deliveries among HIV-positive women in Europe.; In a pooled analysis of data on HIV-positive pregnant women enrolled in the Swiss Mother & Child HIV Cohort Study and the European Collaborative Study 2000 to 2010, deliveries were classified as occurring pre- or postpublication of national guidelines recommending vaginal delivery.; Overall, 2663 women with 3013 deliveries were included from 10 countries; 28% women were diagnosed with HIV during pregnancy. Combination antiretroviral therapy was used in most pregnancies (2020, 73%), starting during the first or second trimester in 78% and during the third trimester in 22%; in 25% pregnancies, the woman conceived on combination antiretroviral therapy. Overall, in 86% pregnancies, a VL > 400 copies per milliliter was achieved before delivery. The proportion of vaginal deliveries increased from 17% (414/2377) before the change in guidelines to 52% (313/600) after; elective Caesarean section rates decreased from 65% to 27%. The proportion of women with undetectable VL having a Caesarean section was 55% after implementation of new guidelines. We observed a decrease of late preterm deliveries from 16% (377/2354) before to 7% (42/599) after the change in guidelines (P > 0.001).; There are still missed opportunities for women with HIV to fully suppress their VL and to deliver vaginally in Europe.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Biostatistics > Biostatistics - Frequency Modelling (Schindler)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
UniBasel Contributors:Glass, Tracy
Item Type:Article, refereed
Bibsysno:Link to catalogue
Publisher:Raven Press
ISSN:0894-9255
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:27 Feb 2014 15:46
Deposited On:27 Feb 2014 15:46

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