The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery.
OBJECTIVE
To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART).


METHODS
Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n=98).


METHODS
Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands.


METHODS
Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women.


METHODS
MTCT, preterm delivery, low birthweight, pre-eclampsia.


RESULTS
MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P=0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls.


CONCLUSIONS
We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.
Boer
K
K
Department of Obstetrics, Academic Medical Center, University of Amsterdam, The Netherlands. k.boer@amc.uva.nl
Nellen
J F
JF
Patel
D
D
Timmermans
S
S
Tempelman
C
C
Wibaut
M
M
Sluman
M A
MA
van der Ende
M E
ME
Godfried
M H
MH
D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001724:Birth Weight; D016022:Case-Control Studies; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D007752:Obstetric Labor, Premature / Q000209:etiology; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011256:Pregnancy Outcome; D012044:Regression Analysis; D012307:Risk Factors; D019562:Viral Load