[Pregnancy in HIV-positive women: 6 years of activity of the Regional Reference Center].
OBJECTIVE
With this study, we wanted to evaluate HIV-positive pregnant mothers followed at the HIV Reference Center of Friuli Venezia Giulia and to describe obstetric treatment aimed at identifying vertical transmission factors and at undertaking a correct diagnostic-therapeutic approach to this patient group. The data include a large case series from the European Collaborative Study on HIV in Pregnancy, in which our facility is a collaborating center.


METHODS
The protocol includes the administration of personalized antiretroviral therapy to seropositive patients at the first visit. An elective caesarean section is performed at 38 weeks gestation. Antiretroviral therapy is continued in the neonate. Breastfeeding is prohibited.


RESULTS
From 1998 to 2002, 28 pregnant mothers with HIV infection were followed. Most patients came from out of region and had acquired the infection through heterosexual intercourse with a serodiscordant partner. In 1 in 3 patients, a diagnosis of seropositivity was made during pregnancy. One case of vertical transmission was observed.


CONCLUSIONS
When appropriate prevention measures are instituted, the percentage of vertical transmission of infection can be reduced to less than 1% in Europe today. An important part of this effort is early screening for HIV infection in pregnancy. Other fundamental measures are the institution of antiretroviral therapy starting from the first weeks of pregnancy, monitoring of pregnancy at a tertiary reference center, intravenous administration of therapies before caesarean section, possibly not during labor and with the membrane intact. Equally important factors are neonatal therapy, adequate pediatric monitoring after the infant is born and discontinuation of breastfeeding.
Bernardon
M
M
Centro di Riferimento Regionale per l'HIV in Gravidanza e per la Gravidanza ad Alto Rischio, Regione Friuli Venezia Giulia, IRCCS Burlo Garofolo, Trieste.
De Seta
F
F
Maso
G P
GP
Cescutti
V
V
Olivuzzi
M
M
Redaelli
I
I
Alberico
S
S
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001942:Breast Feeding; D002585:Cesarean Section; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D012307:Risk Factors
D044966:Anti-Retroviral Agents