Pregnancy management in HIV viral controllers: twenty years of experience
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
(1) Background: The evidence base for the management of spontaneous viral controllers in pregnancy is lacking. We describe the management outcomes of pregnancies in a series of UK women with spontaneous HIV viral control (<100 copies/mL 2 occasions before or after pregnancy off ART). (2) Methods: A multi-centre, retrospective case series (1999–2021) comparing pre- and post-2012 when guidelines departed from zidovudine-monotherapy (ZDVm) as a first-line option. Demographic, virologic, obstetric and neonatal information were anonymised, collated and analysed in SPSS. (3) Results: A total of 49 live births were recorded in 29 women, 35 pre-2012 and 14 post. HIV infection was more commonly diagnosed in first reported pregnancy pre-2012 (15/35) compared to post (2/14), p = 0.10. Pre-2012 pregnancies were predominantly managed with ZDVm (28/35) with pre-labour caesarean section (PLCS) (24/35). Post-2012 4/14 received ZDVm and 10/14 triple ART, p = 0.002. Post-2012 mode of delivery was varied (5 vaginal, 6 PLCS and 3 emergency CS). No intrapartum ZDV infusions were given post-2012 compared to 11/35 deliveries pre-2012. During pregnancy, HIV was detected (> 50 copies/mL) in 14/49 pregnancies (29%) (median 92, range 51–6084). Neonatal ZDV post-exposure prophylaxis was recorded for 45/49 infants. No transmissions were reported. (4) Conclusion: UK practice has been influenced by the change in guidelines, but this has had little impact on CS rates.
Date Issued
2024-04-01
Date Acceptance
2024-04-03
Citation
Pathogens, 2024, 13 (4)
ISSN
2076-0817
Publisher
MDPI AG
Journal / Book Title
Pathogens
Volume
13
Issue
4
Copyright Statement
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/38668263
PII: pathogens13040308
Subjects
antiretroviral therapy
ANTIRETROVIRAL THERAPY
ASSOCIATION GUIDELINES
elite HIV viral controller
HIV-1 vertical transmission
IMMUNODEFICIENCY-VIRUS TYPE-1
Life Sciences & Biomedicine
Microbiology
obstetric management
OPEN-LABEL
PERINATAL TRANSMISSION
pregnancy
PREVENTION
RISK
RNA
Science & Technology
VERTICAL TRANSMISSION
WOMEN
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
308
Date Publish Online
2024-04-10