Prevention of mother-to-child transmission: experience of a Portuguese centre.
BACKGROUND
HIV infection during pregnancy still raises controversial issues. Combined antiretroviral therapy (cART) has been successful in reducing mother-to-child transmission (MTCT). Routine screening in pregnancy and in pre-conception consultation proved to be one of the best methods able to get this treatment on time. We review our experience with pregnant patients with HIV infection.


METHODS
Retrospective and descriptive study. Data obtained from HIV-infected pregnant women from 1999 to 2012 with delivery and subsequent infectious diseases follow-up at our hospital.


RESULTS
We evaluated 136 patients (169 pregnancies), with a total of 147 living newborns (2 twin pregnancies) and 1 stillbirth. Median age at pregnancy was 30 (SD 5.7) years. Four patients were HIV-2 infected and one HIV-1+2 infected. 26 (19.1%) women were HCV co-infected and 6 (4.4%) HBV co-infected; 1 patient has HCV and HBV co-infection. Sexual risk for HIV acquisition was determined in 102 (75%) patients and 31 (22.8%) were intravenous drug users. 33/136 (24.2%) women were diagnosed on routine screening in pregnancy, 4 during delivery and 2 immediately after delivery. 36 (26.4%) patients had an AIDS-defining entity before pregnancy and no new opportunistic infections were diagnosed. ART was used in 157 (92.9%) pregnancies and 15 (9.5%) of them were treated only with NRTIs. At the time of delivery 86/144 (59.7%) patients had undetectable viral load (VL) (25 patients without VL determined), 91.7% of those on ART. 119 (70.4%) had a TCD4 cell count above 200 cells/mm(3). MTCT occurred in 3/147 cases (2%): in one mother HIV-1 infection was diagnosed three weeks before delivery, other immediately after delivery and the third woman started cART (2NRTI+1PI/r) in the second trimester of pregnancy, always adherent and without secondary effects, VL at delivery was 50 copies/mL and elective C-section was performed.


CONCLUSIONS
The fact that 24% of patients were diagnosed during pregnancy shows the importance of routine screening to all pregnant women. MTCT occurred in three children, but only one was administered cART for prevention.
Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal.
Carmela
C
Piñeiro
Obstetrics and Gynaecology Service, Centro Hospitalar São João, Porto, Portugal.
Sofia
S
Fernandes
Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal.
Cristóvão
C
Figueiredo
Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal.
Ana Sofia
AS
Santos
Obstetrics and Gynaecology Service, Centro Hospitalar São João, Porto, Portugal.
Marina
M
Moucho
Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal.
Rosário
R
Serrão
Obstetrics and Gynaecology Service, Centro Hospitalar São João, Porto, Portugal.
Nuno
N
Montenegro
Infectious Diseases Service, Centro Hospitalar São João, Porto, Portugal.
António
A
Sarmento