@article {1837, title = {Use of zidovudine-sparing HAART in pregnant HIV-infected women in Europe: 2000-2009.}, journal = {J Acquir Immune Defic Syndr}, volume = {57}, year = {2011}, month = {2011 Aug 1}, pages = {326-33}, abstract = {

BACKGROUND: Increasing numbers of women in resource-rich settings are prescribed zidovudine (ZDV)-sparing highly active antiretroviral therapy (HAART) in pregnancy. We compare ZDV-sparing with ZDV-containing HAART in relation to maternal viral load at delivery, mother-to-child transmission (MTCT) of HIV, and congenital abnormality.

METHODS: This is an analysis of data from the National Study of HIV in Pregnancy and Childhood and the European Collaborative Study. Data on 7573 singleton births to diagnosed HIV-infected women between January 2000 and June 2009 were analyzed. Logistic regression models were fitted to estimate adjusted odds ratios (AORs).

RESULTS: Overall, 15.8\% (1199 of 7573) of women received ZDV-sparing HAART, with increasing use between 2000 and 2009 (P < 0.001). Nearly a fifth (18.4\%) of women receiving ZDV-sparing HAART in pregnancy had a detectable viral load at delivery compared with 28.6\% of women on ZDV-containing HAART [AOR 0.90; 95\% confidence interval (CI): 0.72 to 1.14, P = 0.4]. MTCT rates were 0.8\% and 0.9\% in the ZDV-sparing and ZDV-containing groups, respectively (AOR 1.81; 95\% CI: 0.77 to 4.26, P = 0.2). The congenital abnormality rate was the same in both groups (2.7\%, AOR 0.98; 95\% CI: 0.66 to 1.45, P = 0.9), with no significant difference between the groups in a subanalysis of pregnancies with first trimester HAART exposure (AOR 0.79; 95\% CI: 0.48 to 1.30, P = 0.4).

CONCLUSIONS: We found no difference in risk of detectable viral load at delivery, MTCT, or congenital abnormality when comparing ZDV-sparing with ZDV-containing HAART. With increasing use of ZDV-sparing HAART, continued monitoring of pregnancy outcomes and long-term consequences of in utero exposure to these drugs is required.

}, keywords = {Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Europe, Female, HIV Infections, Humans, Infant, Infectious Disease Transmission, Vertical, Pregnancy, Pregnancy Complications, Infectious, Retrospective Studies, Time Factors, Viral Load, Zidovudine}, issn = {1944-7884}, doi = {10.1097/QAI.0b013e31821d34d0}, author = {Tariq, Shema and Townsend, Claire L and Cortina-Borja, Mario and Duong, Trinh and Elford, Jonathan and Thorne, Claire and Tookey, Pat A} } @article {1657, title = {Mode of delivery in HIV-infected pregnant women and prevention of mother-to-child transmission: changing practices in Western Europe.}, journal = {HIV Med}, volume = {11}, year = {2010}, month = {2010 Jul 1}, pages = {368-78}, abstract = {

OBJECTIVES: The aim of the study was to examine temporal and geographical patterns of mode of delivery in the European Collaborative Study (ECS), identify factors associated with elective caesarean section (CS) delivery in the highly active antiretroviral therapy (HAART) era and explore associations between mode of delivery and mother-to-child transmission (MTCT).

METHODS: The ECS is a cohort study in which HIV-infected pregnant women are enrolled and their infants prospectively followed. Data on 5238 mother-child pairs (MCPs) enrolled in Western European ECS sites between 1985 and 2007 were analysed.

RESULTS: The elective CS rate increased from 16\% in 1985-1993 to 67\% in 1999-2001, declining to 51\% by 2005-2007. In 2002-2004, 10\% of infants were delivered vaginally, increasing to 34\% by 2005-2007. During the HAART era, women in Belgium, the United Kingdom and the Netherlands were less likely to deliver by elective CS than those in Italy and Spain [adjusted odds ratio (AOR) 0.07; 95\% confidence interval (CI) 0.04-0.12]. The MTCT rate in 2005-2007 was 1\%. Among MCPs with maternal HIV RNA<400 HIV-1 RNA copies/mL (n=960), elective CS was associated with 80\% decreased MTCT risk (AOR 0.20; 95\% CI 0.05-0.65) adjusting for HAART and prematurity. Two infants born to 559 women with viral loads <50 copies/mL were infected, one of whom was delivered by elective CS (MTCT rate 0.4\%; 95\% CI 0.04-1.29).

CONCLUSIONS: Our findings suggest that elective CS prevents MTCT even at low maternal viral loads, but the study was insufficiently powered to enable a conclusion to be drawn as to whether this applies for viral loads <50 copies/mL. Diverging mode of delivery patterns in Europe reflect uncertainties regarding the risk-benefit balance of elective CS for women on successful HAART.

}, keywords = {Adult, Antiretroviral Therapy, Highly Active, Cesarean Section, Delivery, Obstetric, Epidemiologic Methods, Europe, Female, HIV Infections, Humans, Infant, Infant, Newborn, Infectious Disease Transmission, Vertical, Pregnancy, Pregnancy Complications, Infectious, Premature Birth, Prenatal Care, Reverse Transcriptase Inhibitors, Substance Abuse, Intravenous, Viral Load, Young Adult, Zidovudine}, issn = {1468-1293}, doi = {10.1111/j.1468-1293.2009.00800.x}, author = {Boer, K and England, K and Godfried, M H and Thorne, C} }