title: Pregnancy among HIV-infected refugees in Rhode Island.
abstract: In 1999, immigration laws lifted previous barriers, allowing more HIV-infected refugees entrance to the US. Many of these refugees are women of reproductive age. At our center in Providence, RI, a significant number of HIV-infected refugees have become pregnant since resettling in the US. We describe the pregnancies seen among these predominantly West African HIV-infected refugees. A retrospective chart review was conducted on all HIV-infected female refugees who established care from 2000-2006. Descriptive statistics were used to describe the population at this site. We found that between 2000 and 2006, 28 HIV-infected female refugees established care. Liberia was the country of origin of 79% (22) of the women. There were 20 pregnancies among 14 women between 2000-2006. The median time from resettlement in the US to first pregnancy was 16 (<1-69) months. The median age at time of first pregnancy was 29 years (19-39). At time of pregnancy, the median CD4 count was 506 cells/mL and the median plasma viral load (PVL) was 3.36 log10 copies/ml. There were nine deliveries, one current pregnancy and one loss to follow-up. Other pregnancy outcomes included five terminations and three spontaneous abortions. All women received antiretroviral therapy during their pregnancy. At the time of delivery the median PVL was <1.88 log. There was one HIV transmission from mother to child. Two women became pregnant while on efavirenz, which was subsequently discontinued. One of the women delivered a normal term infant; the other relocated and transferred her care. Among this cohort of HIV-infected refugees, there is a high rate of pregnancy, highlighting the need for timely initiation of medical care, including comprehensive preconception counseling, upon resettlement in the US. It is important to gain a better understanding of this unique and growing population in order to provide the best possible care for these women.
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA. eblood@bidmc.harvard.edu
authors.forename: Erica
authors.initials: E
authors.lastname: Blood
authors.forename: Curt
authors.initials: C
authors.lastname: Beckwith
authors.forename: Lauri
authors.initials: L
authors.lastname: Bazerman
authors.forename: Susan
authors.initials: S
authors.lastname: Cu-Uvin
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mitty
mesh_terms: D000293:Adolescent; D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use; D048588:Benzoxazines / Q000627:therapeutic use; D003521:Cyclopropanes; D054242:Emigrants and Immigrants; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000208:ethnology*; D006801:Humans; D007988:Liberia / Q000208:ethnology; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000208:ethnology*; D011256:Pregnancy Outcome; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012237:Rhode Island; D055815:Young Adult
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; C098320:efavirenz