@article {8506, title = {Amniocentesis and chorionic villus sampling in HIV-infected pregnant women: a multicentre case series.}, journal = {BJOG}, volume = {124}, year = {2017}, month = {2017 Jul}, pages = {1218-1223}, abstract = {

OBJECTIVES: To assess in pregnant women with HIV the rates of amniocentesis and chorionic villus sampling (CVS), and the outcomes associated with such procedures.

DESIGN: Observational study. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used.

SETTING: University and hospital clinics.

POPULATION: Pregnant women with HIV.

METHODS: Temporal trends were analysed by analysis of variance and by the Chi-square test for trend. Quantitative variables were compared by Student{\textquoteright}s t-test and categorical data by the Chi-square test, with odds ratios and 95\% confidence intervals calculated.

MAIN OUTCOME MEASURES: Rate of invasive testing, intrauterine death, HIV transmission.

RESULTS: Between 2001 and 2015, among 2065 pregnancies in women with HIV, 113 (5.5\%) had invasive tests performed. The procedures were conducted under antiretroviral treatment in 99 cases (87.6\%), with a significant increase over time in the proportion of tests performed under highly active antiretroviral therapy (HAART) (100\% in 2011-2015). Three intrauterine deaths were observed (2.6\%), and 14 pregnancies were terminated because of fetal anomalies. Among 96 live newborns, eight had no information available on HIV status. Among the remaining 88 cases with either amniocentesis (n = 75), CVS (n = 12), or both (n = 1), two HIV transmissions occurred (2.3\%). No HIV transmission occurred among the women who were on HAART at the time of invasive testing, and none after 2005.

CONCLUSIONS: The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment.

TWEETABLE ABSTRACT: No HIV transmission occurred among women who underwent amniocentesis or CVS under effective anti-HIV regimens.

}, keywords = {Adult, Amniocentesis, Analysis of Variance, Anti-Retroviral Agents, Chi-Square Distribution, Chorionic Villi Sampling, Female, Fetal Death, HIV Infections, Humans, Infectious Disease Transmission, Vertical, Odds Ratio, Pregnancy, Pregnancy Complications, Infectious}, issn = {1471-0528}, doi = {10.1111/1471-0528.14183}, author = {Floridia, M and Masuelli, G and Meloni, A and Cetin, I and Tamburrini, E and Cavaliere, A F and Dalzero, S and Sansone, M and Alberico, S and Guerra, B and Spinillo, A and Chiad{\`o} Fiorio Tin, M and Ravizza, M} } @article {10507, title = {Pregnant with HIV before age 25: data from a large national study in Italy, 2001-2016.}, journal = {Epidemiol Infect}, volume = {145}, year = {2017}, month = {2017 08}, pages = {2360-2365}, abstract = {

Young pregnant women with HIV may be at significant risk of unplanned pregnancy, lower treatment coverage, and other adverse pregnancy outcomes. In a large cohort of pregnant women with HIV in Italy, among 2979 pregnancies followed in 2001-2016, 9{\textperiodcentered}0\% were in women <25 years, with a significant increase over time (2001-2005: 7{\textperiodcentered}0\%; 2006-2010: 9{\textperiodcentered}1\%; 2011-2016: 12{\textperiodcentered}2\%, P < 0{\textperiodcentered}001). Younger women had a lower rate of planned pregnancy (23{\textperiodcentered}2\% vs. 37{\textperiodcentered}7\%, odds ratio (OR) 0{\textperiodcentered}50, 95\% confidence interval (CI) 0{\textperiodcentered}36-0{\textperiodcentered}69), were more frequently diagnosed with HIV in pregnancy (46{\textperiodcentered}5\% vs. 20{\textperiodcentered}9\%, OR 3{\textperiodcentered}29, 95\% CI 2{\textperiodcentered}54-4{\textperiodcentered}25), and, if already diagnosed with HIV before pregnancy, were less frequently on antiretroviral treatment at conception (<25 years: 56{\textperiodcentered}3\%; ⩾25 years: 69{\textperiodcentered}0\%, OR 0{\textperiodcentered}58, 95\% CI 0{\textperiodcentered}41-0{\textperiodcentered}81). During pregnancy, treatment coverage was almost universal in both age groups (98{\textperiodcentered}5\% vs. 99{\textperiodcentered}3\%), with no differences in rate of HIV viral suppression at third trimester and adverse pregnancy outcomes. The data show that young women represent a growing proportion of pregnant women with HIV, and are significantly more likely to have unplanned pregnancy, undiagnosed HIV infection, and lower treatment coverage at conception. During pregnancy, antiretroviral treatment, HIV suppression, and pregnancy outcomes are similar compared with older women. Earlier intervention strategies may provide additional benefits in the quality of care for women with HIV.

}, keywords = {Adolescent, Cohort Studies, Female, HIV Infections, Humans, Italy, Odds Ratio, Pregnancy, Young Adult}, issn = {1469-4409}, doi = {10.1017/S0950268817001340}, author = {Floridia, M and Masuelli, G and Tamburrini, E and Cetin, I and Liuzzi, G and Martinelli, P and Guaraldi, G and Spinillo, A and Vimercati, A and Maso, G and Pinnetti, C and Frisina, V and Dalzero, S and Ravizza, M} } @article {10575, title = {Rate, correlates and outcomes of repeat pregnancy in HIV-infected women.}, journal = {HIV Med}, volume = {18}, year = {2017}, month = {2017 07}, pages = {440-443}, abstract = {

OBJECTIVES: The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection.

METHODS: Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load.

RESULTS: The rate of repeat pregnancy among 3007 women was 16.2\%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95\% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95\% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95\% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4\%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6\%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7\%, respectively) and of low birth weight (23.4 vs. 15.4\%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3\%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1\%, respectively).

CONCLUSIONS: Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.

}, keywords = {Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Emigrants and Immigrants, Female, HIV Infections, HIV-1, Humans, Infant, Low Birth Weight, Pregnancy, Premature Birth, Viral Load}, issn = {1468-1293}, doi = {10.1111/hiv.12473}, author = {Floridia, M and Tamburrini, E and Masuelli, G and Martinelli, P and Spinillo, A and Liuzzi, G and Vimercati, A and Alberico, S and Maccabruni, A and Pinnetti, C and Frisina, V and Dalzero, S and Ravizza, M} }