title: Pregnancy outcomes in women with advanced HIV infection in Italy.
abstract: Pregnancy has been associated with a low risk of HIV disease progression. Most pregnancies with HIV currently involve women who have not experienced AIDS-defining events, and are clinically classified as Centers for Disease Control and Prevention (CDC) groups A or B. We evaluated the main maternal outcomes among pregnant women with more advanced HIV disease, defined by CDC-C disease stage. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used. A total of 566 HIV-infected mothers, 515 in stage A or B (CDC-AB group) and 51 in stage C (CDC-C group) were evaluated. The two groups had similar baseline characteristics. No differences were found in the main maternal and neonatal outcomes. Most of the women achieved viral suppression at end of pregnancy (>1000 copies per milliliter: CDC-C: 17.2%; CDC-AB: 13.7%). One year after delivery, HIV replication (HIV-RNA >1000 copies per milliliter) was present in 11.5% of CDC-AB women and 30.0% CDC-C women. Despite lower initial CD4 counts (300 versus 481 cells per microliter), CDC-C women maintained stable CD4 levels during pregnancy, and 1 year after delivery, a significant increase in CD4 count from preconception values was observed in both groups (CDC-C: +72 cells per microliter, p=0.031; CDC-AB: +43 cells per microliter, p<0.001). Only one AIDS event occurred in a woman with a previous diagnosis of AIDS. In CDC-C women, pregnancy is not associated with an increased rate of adverse maternal or neonatal outcomes, and a good immunovirologic response can be expected. During postpartum care, women with more advanced HIV infection should receive particular care to prevent loss of virologic suppression.
authors.affiliation: Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Baroncelli
authors.forename: Enrica
authors.initials: E
authors.lastname: Tamburrini
authors.forename: Marina
authors.initials: M
authors.lastname: Ravizza
authors.forename: Carmela
authors.initials: C
authors.lastname: Pinnetti
authors.forename: Serena
authors.initials: S
authors.lastname: Dalzero
authors.forename: Manuela
authors.initials: M
authors.lastname: Scatà
authors.forename: Alessandra
authors.initials: A
authors.lastname: Crepaldi
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Liuzzi
authors.forename: Atim
authors.initials: A
authors.lastname: Molinari
authors.forename: Antonella
authors.initials: A
authors.lastname: Vimercati
authors.forename: Anna
authors.initials: A
authors.lastname: Maccabruni
authors.forename: Daniela
authors.initials: D
authors.lastname: Francisci
authors.forename: Elena
authors.initials: E
authors.lastname: Rubino
authors.forename: Marco
authors.initials: M
authors.lastname: Floridia
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D018450:Disease Progression; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000145:classification / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D011256:Pregnancy Outcome; D012307:Risk Factors; D012720:Severity of Illness Index; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents