Diagnosis of HIV infection in pregnancy: data from a national cohort of pregnant women with HIV in Italy.
We analysed the characteristics of the pregnancies with a previously undetected HIV infection in a national observational study of pregnant women with HIV in Italy. In a total of 443 pregnancies with available date of HIV diagnosis, 118 were characterized by a previously undetected HIV infection (26.6%, 95% CI 22.5-30.8). The following factors were independently associated with this occurrence in a multivariate analysis (adjusted odds ratios; 95% CIs): foreign nationality (5.1, 2.8-9.3); no pre-conception counselling (35.9, 4.8-266.1); first pregnancy (2.1, 1.2-4.0); asymptomatic status (6.8, 1.5-30.6). Women with previously undetected infection started antiretroviral treatment significantly later during pregnancy (P < 0.001). Missed diagnosis was responsible for one case of transmission. A high rate of previously undetected HIV infection was observed. This suggests a good HIV detection during pregnancy, but also the need to reinforce HIV testing strategies among women of childbearing age. We identified some determinants which may be considered for intervention measures.
Floridia
M
M
Istituto Superiore di Sanità (ISS), Department of Drug Evaluation and Research, Rome, Italy. floridia@iss.it
Ravizza
M
M
Tamburrini
E
E
Anzidei
G
G
Tibaldi
C
C
Maccabruni
A
A
Guaraldi
G
G
Alberico
S
S
Vimercati
A
A
Degli Antoni
A
A
Ferrazzi
E
E
D000328:Adult; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003951:Diagnostic Errors; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D011159:Population Surveillance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D018709:Statistics, Nonparametric