Management of Human Immunodeficiency Virus–Infected Pregnant Women at Latin American and Caribbean Sites

Read, Jennifer S.; Cahn, Pedro; Losso, Marcelo; Pinto, Jorge; Joao, Esau; Duarte, Geraldo; Cardoso, Edmundo; Freimanis-Hance, Laura; Stoszek, Sonia K.; NISDI Perinatal Study Group

Management of Human Immunodeficiency Virus–Infected Pregnant Women at Latin American and Caribbean Sites

Date

2007

Authors

Freimanis-Hance, Laura

Stoszek, Sonia K.

NISDI Perinatal Study Group

Abstract

Objective: To describe the management of a population of human immunodeficiency virus (HIV)-infected pregnant women in Latin America and the Caribbean, and to assess factors associated with maternal viral load of 1,000 copies/mL or more and with infant HIV-1 infection. Methods: Eligibility criteria were enrollment in the prospective cohort study as of March 2006; delivery of a liveborn, singleton infant; and completion of the 6-month postpartum or postnatal visit. Results: Of 955 women enrolled in Argentina, the Bahamas, Brazil, and Mexico, 770 mother-infant pairs were eligible. At enrollment, most women were relatively healthy (87% asymptomatic, 59% with viral load less than 1,000 copies/mL, 62% with CD4(+)% of 25% or more). Most (99%) received antiretrovirals during pregnancy (56% prophylaxis, 44% treatment), and 38% delivered by cesarean before labor and before ruptured membranes. Only 18% of women had a viral load of 1,000 copies/mL or more after delivery (associated in adjusted analyses with receipt of antiretrovirals at conception, CD4(+)% [lower], viral load [higher], and country at enrollment, enrollment late in pregnancy, and inversely related to antiretroviral regimen [two nucleoside or nucleotide analogue reverse transcriptase inhibitors plus one nonnucleoside reverse transcriptase inhibitor] during pregnancy). None of the infants breastfed, and all received antiretroviral prophylaxis. Seven infants became infected (0.91%; 95% confidence interval 0.37-1.86). Low birth weight infants and those whose mothers had a low CD4(+)% at hospital discharge after delivery and were not receiving antiretrovirals at enrollment were at higher risk of HIV infection. Conclusion: Only a minority of women had a viral load of 1,000 copies/mL or more around delivery, and mother-to-child transmission of HIV occurred rarely (1%).

Keywords

Management, Human Immunodeficiency Virus, Pregnant Women, Latin American, Caribbean Sites

Citation

Read, J. S., Cahn, P., Losso, M., Pinto, J., Joao, E., Duarte, G., ... Stoszek, S. K. (2007). Management of human immunodeficiency virus–infected pregnant women at Latin American and Caribbean sites. Obstetrics & Gynecology.