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. 2011;16(6):895-903.
doi: 10.3851/IMP1849.

Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe

European Collaborative Study in EuroCoord  1 ; Heather Bailey, Claire Townsend, Mario Cortina-Borja, Claire Thorne
Collaborators, Affiliations

Insufficient antiretroviral therapy in pregnancy: missed opportunities for prevention of mother-to-child transmission of HIV in Europe

European Collaborative Study in EuroCoord et al. Antivir Ther. 2011.

Abstract

Background: Although mother-to-child transmission (MTCT) rates are at an all-time low in Western Europe, potentially preventable transmissions continue to occur. Duration of antenatal combination antiretroviral therapy (ART) is strongly associated with MTCT risk.

Methods: Data on pregnant HIV-infected women enrolled in the Western and Central European sites of the European Collaborative Study between January 2000 and July 2009 were analysed. The proportion of women receiving no antenatal ART or 1-13 days of treatment was investigated, and associated factors explored using logistic regression models.

Results: Of 2,148 women, 142 (7%) received no antenatal ART, decreasing from 8% in 2000-2003 to 5% in 2004-2009 (χ(2)=8.73; P<0.01). A further 41 (2%) received 1-13 days of ART. One-third (64/171) of women with 'insufficient' (0 or 1-13 days) antenatal ART had a late HIV diagnosis (in the third trimester or intrapartum), but half (85/171) were diagnosed before conception. Pre-term delivery <34 weeks was associated with receipt of no and 1-13 days antenatal ART (adjusted odds ratios [ORs] 2.9 [P<0.01] and 4.5 [P<0.01], respectively). History of injecting drug use was associated with an increased risk of no ART (adjusted OR 2.9; P<0.01) and severe symptomatic HIV disease with a decreased risk (adjusted OR 0.2; P<0.01). MTCT rates were 1.1% (15/1,318) among women with ≥14 days antenatal ART and 7.4% (10/136) among those with insufficient ART.

Conclusions: Over the last 10 years, around one in 11 women in this study received insufficient antenatal ART, accounting for 40% of MTCTs. One-half of these women were diagnosed before conception, suggesting disengagement from care.

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Figures

Figure 1
Figure 1
Availability of data on outcome of “insufficient” (<14 days) antenatal antiretroviral therapy (ART) †Women with missing ART start date are included in the ≥14 days antenatal ART group in all analyses
See this image and copyright information in PMC

References

    1. Warszawski J, Tubiana R, Le Chenadec J, et al. Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS. 2008;22(2):289–99. - PubMed
    1. Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS. 2008;22(8):973–81. - PubMed
    1. European Collaborative Study The mother-to-child HIV transmission epidemic in Europe: evolving in the East and established in the West. AIDS. 2006;20:1419–27. - PubMed
    1. National Study of HIV in Pregnancy and Childhood, NHS Audit Information Analysis Unit, Children’s HIV Association . Audit Information and Analysis Unit for London. Kent, Surrey and Sussex, Essex, Beds & Herts; 2007. Perinatal transmission of HIV in England 2002-2005.
    1. Deblonde J, Claeys P, Temmerman M. Antenatal HIV screening in Europe: a review of policies. European Journal of Public Health. 2007;17(5):414–8. - PubMed

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