Missed opportunities among HIV-positive women to control viral replication during pregnancy and to have a vaginal delivery.
Details
Serval ID
serval:BIB_5084FE5D019E
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Missed opportunities among HIV-positive women to control viral replication during pregnancy and to have a vaginal delivery.
Journal
Journal of Acquired Immune Deficiency Syndromes
Working group(s)
European Collaborative Study in EuroCoord, Swiss Mother & Child HIV Cohort Study
Contributor(s)
Thorne C., Bailey H., Giaquinto C., Rampon O., Mazza A., De Rossi A., Wörner I., Mok J., de José MI. , Martínez£££B Larrú£££ B. , Peña J., Garcia J., Lopez JR., Rodriguez MC., Asensi-Botet F., Otero MC., Pérez-Tamarit D., Scherpbier HJ., Kreyenbroek M., Godfried MH., Nellen FJ., Boer K., Navér L., Bohlin AB., Lindgren S., Kaldma A., Belfrage E., Levy J., Barlow P., Manigart Y., Hainaut M., Goetghebuer T., Brichard B., De Camps J., Thiry N., Deboone G., Waterloos H., Viscoli C., De Maria A., Bentivoglio G., Ferrero S., Gotta C., Mûr A., Payà A., López-Vilchez MA., Carreras R., Valerius NH., Rosenfeldt V., Coll O., Suy A., Perez J., Fortuny C., Boguña J., Savasi V., Fiore S., Crivelli M., Viganò A., Giacomet V., Cerini C., Raimondi C., Zuccotti G., Alberico S., Maso G., Tropea M., Barresi V., Taylor G., Lyall EG., Penn Z., Buffolano W., Tiseo R., Martinelli P., Sansone M., Maruotti G., Agangi A., Tibaldi C., Marini S., Masuelli G., Benedetto C., Niemieç T., Marczynska M., Dobosz S., Popielska J., Oldakowska A., Aubert V., Barth J., Battegay M., Bernasconi E., Böni J., Brazzola P., Bucher HC., Burton-Jeangros C., Calmy A., Cavassini M., Cheseaux JJ., Drack G., Duppenthaler A., Egger M., Elzi L., Fehr J., Fellay J., Francini K., Furrer H., Fux CA., Gorgievski M., Grawe C., Günthard H., Haerry D., Hasse B., Hirsch HH., Hösli I., Kahlert C., Kaiser L., Keiser O., Klimkait T., Kovari H., Ledergerber B., Martinetti G., de Tejada B., Metzner K., Müller N., Nadal D., Pantaleo G., Polli Ch., Posfay-Barbe K., Rauch A., Regenass S., Rickenbach M., Rudin C., Schmid P., Scheibner K., Schultze D., Schöni-Affolter F., Schüpbach J., Speck R., Taffé P., Tarr P., Telenti A., Trkola A., Vernazza P., Weber R., Wyler CA., Yerly S.
ISSN
1944-7884 (Electronic)
ISSN-L
1525-4135
Publication state
Published
Issued date
2013
Peer-reviewed
Oui
Volume
64
Number
1
Pages
58-65
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't Publication Status: ppublish
Abstract
INTRODUCTION: Most national guidelines for the prevention of mother-to-child transmission of HIV in Europe updated between 2001 and 2010 recommend vaginal deliveries for women with undetectable or very low viral load (VL). Our aim was to explore the impact of these new guidelines on the rates of vaginal deliveries among HIV-positive women in Europe.
METHODS: In a pooled analysis of data on HIV-positive pregnant women enrolled in the Swiss Mother & Child HIV Cohort Study and the European Collaborative Study 2000 to 2010, deliveries were classified as occurring pre- or postpublication of national guidelines recommending vaginal delivery.
RESULTS: Overall, 2663 women with 3013 deliveries were included from 10 countries; 28% women were diagnosed with HIV during pregnancy. Combination antiretroviral therapy was used in most pregnancies (2020, 73%), starting during the first or second trimester in 78% and during the third trimester in 22%; in 25% pregnancies, the woman conceived on combination antiretroviral therapy. Overall, in 86% pregnancies, a VL < 400 copies per milliliter was achieved before delivery. The proportion of vaginal deliveries increased from 17% (414/2377) before the change in guidelines to 52% (313/600) after; elective Caesarean section rates decreased from 65% to 27%. The proportion of women with undetectable VL having a Caesarean section was 55% after implementation of new guidelines. We observed a decrease of late preterm deliveries from 16% (377/2354) before to 7% (42/599) after the change in guidelines (P < 0.001).
CONCLUSION: There are still missed opportunities for women with HIV to fully suppress their VL and to deliver vaginally in Europe.
METHODS: In a pooled analysis of data on HIV-positive pregnant women enrolled in the Swiss Mother & Child HIV Cohort Study and the European Collaborative Study 2000 to 2010, deliveries were classified as occurring pre- or postpublication of national guidelines recommending vaginal delivery.
RESULTS: Overall, 2663 women with 3013 deliveries were included from 10 countries; 28% women were diagnosed with HIV during pregnancy. Combination antiretroviral therapy was used in most pregnancies (2020, 73%), starting during the first or second trimester in 78% and during the third trimester in 22%; in 25% pregnancies, the woman conceived on combination antiretroviral therapy. Overall, in 86% pregnancies, a VL < 400 copies per milliliter was achieved before delivery. The proportion of vaginal deliveries increased from 17% (414/2377) before the change in guidelines to 52% (313/600) after; elective Caesarean section rates decreased from 65% to 27%. The proportion of women with undetectable VL having a Caesarean section was 55% after implementation of new guidelines. We observed a decrease of late preterm deliveries from 16% (377/2354) before to 7% (42/599) after the change in guidelines (P < 0.001).
CONCLUSION: There are still missed opportunities for women with HIV to fully suppress their VL and to deliver vaginally in Europe.
Pubmed
Web of science
Create date
25/10/2013 18:05
Last modification date
20/08/2019 15:06
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