Effect of antiretroviral therapy on pregnancy outcome in HIV-1 positive women.
OBJECTIVE
The aim of this study was to assess the effect of antiretroviral therapy (ART) on pregnancy outcome.


METHODS
The study included 102 HIV-1-infected pregnant women. We investigated maternal and gestational age at delivery, time of ART initiation, mode of delivery, birth weight, maternal CD4 count and HIV-1 viral load at delivery and also drug use during pregnancy. Infant HIV-1 status was used to determine the rate of vertical transmission of HIV-1.


RESULTS
Antiretroviral therapy was given to 81 (79.4%) patients, on zidovudine monotherapy there were 35 (34.4%) women, on Highly Active Antiretroviral Therapy (HAART) with a protease inhibitor (PI) there were 18 (17.6%) patients and 28 (27.4%) patients on HAART with no PI regimen. Overall rate of pre-term delivery (before 37 weeks of gestation) was estimated as 11.8% (12 out of 102). Premature delivery occurred in 16.7% of women on HAART with PI and in 17.9% of women on HAART without PI as compared to any case in patients not receiving ART. Combined therapy was started before pregnancy or during the first trimester in 62.5% of women who delivered prematurely versus 15,6% who gave birth at term. Low birth weight (<2500 grams) occurred in 13 of 81 (16%) newborns of treated mothers and in 2 of 21 (9.5%) children when mothers did not get any therapy. The highest risk of infant low birth weight was associated with receiving HAART containing PI (22.2% vs. 13.3% in the group of non-treated women). Vaginal deliveries occurred among 67.9% women on HAART without PI and in 76.5% of non-treated women. Elective caesarean section was performed in 28.1% of women under monotherapy and in 17.6% of non-treated women. Emergency caesarean section was highly prevalent in women on HAART without PI (14.2%) compared to non-treated women (5.9%). Rate of mother to child HIV-1 transmission among treated women was 8.8% as compared to 25% when no ARV therapy during pregnancy was used. No infected infants were born to mothers on HAART. Non-treated women had lower CD4 cell count and higher HIV-1 viral load at delivery.


CONCLUSIONS
Pre-term deliveries were highly prevalent among women on HAART during pregnancy, especially when therapy was started before or in the first trimester of pregnancy. Women receiving HAART with PI were at a higher risk of delivering a baby with low birth weight. Antiretroviral therapy during pregnancy, together with elective caesarean section, was associated with a reduced risk of mother to child transmission of HIV-1.
Kowalska
Aneta
A
Department of Obstetrics and Gynaecology, Institute of Mother and Child, 17A Kasprzaka St., 01-211 Warsaw, Poland.
Niemiec
Tomasz
T
El Midaoui
Asmaa
A
Burkacka
Ewa
E
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D001724:Birth Weight; D018791:CD4 Lymphocyte Count; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007752:Obstetric Labor, Premature / Q000209:etiology* / Q000517:prevention & control; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011256:Pregnancy Outcome; D019562:Viral Load; D015215:Zidovudine / Q000009:adverse effects* / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine