Pregnancy outcomes in women with advanced HIV infection in Italy

Abstract

Pregnancy has been associated with a low risk of HIV disease progression. Most pregnancies with HIV currently involve women who have not experienced AIDS-defining events, and are clinically classified as Centers for Disease Control and Prevention (CDC) groups A or B. We evaluated the main maternal outcomes among pregnant women with more advanced HIV disease, defined by CDC-C disease stage. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. A total of 566 HIV-infected mothers, 515 in stage A or B (CDC-AB group) and 51 in stage C (CDC-C group) were evaluated. The two groups had similar baseline characteristics. No differences were found in the main maternal and neonatal outcomes. Most of the women achieved viral suppression at end of pregnancy (>1000 copies per milliliter: CDC-C: 17.2%; CDC-AB: 13.7%). One year after delivery, HIV replication (HIV-RNA >1000 copies per milliliter) was present in 11.5% of CDC-AB women and 30.0% CDC-C women. Despite lower initial CD4 counts (300 versus 481 cells per microliter), CDC-C women maintained stable CD4 levels during pregnancy, and 1 year after delivery, a significant increase in CD4 count from preconception values was observed in both groups (CDC-C: +72 cells per microliter, p=0.031; CDC-AB: +43 cells per microliter, p<0.001). Only one AIDS event occurred in a woman with a previous diagnosis of AIDS. In CDC-C women, pregnancy is not associated with an increased rate of adverse maternal or neonatal outcomes, and a good immunovirologic response can be expected. During postpartum care, women with more advanced HIV infection should receive particular care to prevent loss of virologic suppression.

FIG. 1.

Proportion of women on nucleotide reverse transcriptase inhibitors (NRTI), non-nucleotide reverse transcriptase inhibitors (NNRTI), and protease inhibitors (PI) (A) at conception and (B) at delivery, by Centers for Disease Control and Prevention (CDC) HIV severity disease. Gray bars: CDC-C group; white bars: CDC-AB group.

FIG. 2.

Proportion of women with HIV-1 RNA >1000 copies per milliliter at different times (preconception, pregnancy, postdelivery). Gray bars, CDC-C group; white bars, CDC-AB group. n: CDC-C: 37; CDC-AB: 316 (available preconception HIV-RNA values). CDC, Centers for Disease Control and Prevention.

FIG. 3.

CD4 cell count at different times (preconception, pregnancy, postdelivery). ■, CDC-C group; ○, CDC-AB group. n: CDC-C: 44; CDC-AB: 366 (available preconception CD4 values). CDC, Centers for Disease Control and Prevention.