Pregnancy outcome among HIV-infected women in the Helsinki metropolitan area.
BACKGROUND
Antiretroviral medication and good obstetric practice have greatly reduced the rate of vertical transmission of human immunodeficiency virus (HIV) infection. The incidence of HIV infection has remained low in Finland. Universal antenatal screening has been offered to all pregnant women since 1998.


METHODS
We analyzed the outcomes of 52 pregnancies among 45 HIV-infected mothers delivering at our department during 1993-2003. A multidisciplinary team planned the management strategy individually and supported the mother's adherence to treatment.


RESULTS
The incidence of HIV infection among women delivering in our hospital district increased from 0.6/10,000 (95% CI 0-1.6) to 4.8/10,000 (95% CI 1.4-8.2) between 1993 and 2002. HIV infection was diagnosed during pregnancy in 40% (18/45) of the mothers. Antiretroviral medication was used prior to pregnancy in 17 (33%) cases; in 34 (66%) cases of the pregnancies, medication was started during the pregnancy. A good virological response (i.e. HIV RNA load <1000/ml during the last trimester) to antiretroviral medication was achieved in 90% (36/40) of the patients; in 60% (24/40) of cases, the HIV RNA load was below the assay detection limit. One mother with advanced HIV infection succumbed to pneumonia shortly after delivery. Of the infants, 92% were born at term, and their mean (+/-SD) birth weight was 3350 +/- 395 g. The Caesarean section (CS) rate was 25% (13/52). All newborns were in good condition, and their mean umbilical pH was 7.23. All newborns received antiretroviral medication. One infant was infected with HIV, the mother was found HIV-positive postpartum. None of the infants born to mothers known to be HIV positive were infected.


CONCLUSIONS
A combination of universal antenatal screening and multidisciplinary management allows individualized treatment and prevents vertical transmission of HIV infection.
Lehtovirta
Päivi
P
Department of Obstetrics and Gynecology, University of Helsinki, Helsinki, Finland.
Skogberg
Kirsi
K
Salo
Eeva
E
Ammälä
Pirkko
P
Ristola
Matti
M
Suni
Jukka
J
Paavonen
Jorma
J
Heikinheimo
Oskari
O
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D005260:Female; D005387:Finland / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D015994:Incidence; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008403:Mass Screening; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D011256:Pregnancy Outcome; D011295:Prenatal Care; D019562:Viral Load
D019380:Anti-HIV Agents