title: Pregnancy outcomes among ART-naive and ART-experienced HIV-positive women: data from the ICONA foundation study group, years 1997-2013.
abstract: BACKGROUND
  We analyzed antiretroviral therapy (ART) regimens and pregnancy outcomes in naive and ART-experienced HIV-positive women from Italian Cohort Naive Antiretrovirals cohort and investigated frequency and predictors of detectable viral load (VL) at delivery.
  
  
  METHODS
  All pregnancies resulting in live births were included. Based on ART at the beginning of pregnancy, pregnancies were allocated either to the ART-naive or ART-experienced group. Analyses were stratified according to calendar periods. Multivariate logistic regression was used to describe predictors of detectable VL at delivery.
  
  
  RESULTS
  One hundred fifty-eight of 2862 women experienced 169 pregnancies (88 in naives and 81 in 70 ART-experienced women). ART regimens varied according to calendar periods; mono-dual combination regimens progressively decreased over time (P value for trend <0.0001). Protease inhibitor-including regimens were the most frequently used regimens at delivery (71.6% vs 63.0% in naives and in ART experienced, P = 0.2). VL was detectable in 35.6% of women at delivery; this was less likely with increasing calendar periods (adjusted odds ratio per 1-year longer: 0.8, 95% confidence interval: 0.7 to 0.9, P = 0.007) and more likely in women with HIV RNA >50 copies per milliliter at pregnancy ascertainment (adjusted odds ratio: 7.1, 95% confidence interval: 1.9 to 33.3, P = 0.006). Nevertheless, no cases of vertical transmission were diagnosed. Preterm birth rate of 17.3% (11.9% vs 22.6% naive and ART experienced, P = 0.1) was reported; this was not associated with ART duration or protease inhibitor-including regimens; 27.2% of infants had <2500 g birth weight.
  
  
  CONCLUSIONS
  Antiretroviral regimens prescribed during pregnancy changed over time according to guidelines. Although undetectable VL was not always achieved, no vertical transmission occurred; preterm delivery and low birth weight occurred in some cases and still remain key issues.
authors.affiliation: *Department of Health Sciences, Clinic of Infectious and Tropical Diseases, University of Milan, Milan, Italy; †Infectious Diseases, San Raffaele Hospital, Milan, Italy; ‡Infectious Diseases, Bagno a Ripoli Hospital, Florence, Italy; §Department of Health and Infectious Diseases, University La Sapienza, Polo Pontino, Rome, Italy; ‖Infectious Diseases, INMI "L. Spallanzani," I.R.C.C.S, Rome, Italy; ¶Infectious Diseases, Galliera Hospital, Genova, Italy; #Infectious Diseases, University of Perugia, Perugia, Italy; **Clinical Immunology, University of Ancona, Ancona, Italy; ††Infectious Diseases, University Sacro Cuore, Rome, Italy; ‡‡Division of Infectious and Tropical Diseases, Spedali Civili, University of Brescia, Brescia, Italy; and §§INMI "L. Spallanzani," I.R.C.C.S, Epidemiology, Rome, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: d'Arminio Monforte
authors.forename: Laura
authors.initials: L
authors.lastname: Galli
authors.forename: Sergio
authors.initials: S
authors.lastname: Lo Caputo
authors.forename: Miriam
authors.initials: M
authors.lastname: Lichtner
authors.forename: Carmela
authors.initials: C
authors.lastname: Pinnetti
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Bobbio
authors.forename: Daniela
authors.initials: D
authors.lastname: Francisci
authors.forename: Andrea
authors.initials: A
authors.lastname: Costantini
authors.forename: Antonella
authors.initials: A
authors.lastname: Cingolani
authors.forename: Francesco
authors.initials: F
authors.lastname: Castelli
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Antonella
authors.initials: A
authors.lastname: Castagna
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007558:Italy; D015999:Multivariate Analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology; D011256:Pregnancy Outcome; D011480:Protease Inhibitors / Q000627:therapeutic use; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D012367:RNA, Viral