HIV-infected pregnant women and vertical transmission in Europe since 1986. European collaborative study.
OBJECTIVE
To describe changes over a 15-year period in characteristics and management of HIV-infected pregnant women in Europe.


METHODS
Prospective study.


METHODS
Analysis of prospective data on 2876 pregnant HIV-infected women and their 3076 infants. Factors examined included maternal socio-demographic, immunological and virological characteristics, antiretroviral therapy and pregnancy outcome.


RESULTS
Among women enrolled, the proportion with heterosexual acquisition of infection has increased significantly from 59% (201/342) in 1985-1987 to 69% (327/471) after 1997 while the proportion acquiring HIV through injecting drug use has declined. Overall median CD4 cell count was 440 x 106/l and 41% of women had undetectable viral load at delivery. In 1995 28% (72/256) of mother-child pairs received the full 076 regimen to reduce risk of vertical transmission, rising significantly to 89% (116/130) by 1999. Use of triple therapy started in pregnancy has increased significantly from < 1% (1/153) in 1997 to 44% (47/107) in 1999. Exposure to antiretroviral therapy was not associated with prevalence or pattern of congenital abnormalities (P = 0.88) but was associated with reversible anaemia in the infant (P < 0.002). The elective cesarean section rate has increased from 10% in 1992 to 71% in 1999/2000. The vertical transmission rate declined from 15.5% by 1994 to 2.6% after 1998. In multivariate analysis, adjusting for maternal CD4 cell count, risk of vertical transmission was reduced by 66% (95% confidence interval, 37-82%) with the full 076 regimen and by 60% (95% confidence interval, 33-73%) with elective cesarean section delivery.


CONCLUSIONS
Changes in treatment of adult HIV disease have affected the management of infected pregnant women. Despite therapeutic and surgical interventions, vertical transmission still occurs.
D000751:Anemia, Neonatal / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D002675:Child, Preschool; D000013:Congenital Abnormalities / Q000453:epidemiology; D036861:Delivery, Obstetric; D019468:Disease Management; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012959:Socioeconomic Factors; D019562:Viral Load
D019380:Anti-HIV Agents