Rate, correlates and outcomes of repeat pregnancy in HIV-infected women

M Floridia; E Tamburrini; G Masuelli; P Martinelli; A Spinillo; G Liuzzi; A Vimercati; S Alberico; A Maccabruni; C Pinnetti; V Frisina; S Dalzero; M Ravizza; Italian Group for Surveillance of Antiretroviral Treatment in Pregnancy

doi:10.1111/hiv.12473

Rate, correlates and outcomes of repeat pregnancy in HIV-infected women

HIV Med. 2017 Jul;18(6):440-443. doi: 10.1111/hiv.12473. Epub 2016 Dec 21.

Authors

Collaborators

Italian Group for Surveillance of Antiretroviral Treatment in Pregnancy:
F Mori, P Ortolani, E R Dalle Nogare, F Di Lorenzo, G Sterrantino, M Meli, S Polemi, J Nocentini, M Baldini, G Montorzi, M Mazzetti, P Rogasi, B Borchi, F Vichi, B Del Pin, E Pinter, E Anzalone, R Marocco, C Mastroianni, V S Mercurio, A Carocci, E Grilli, M Zaramella, B Mariani, G Natalini Raponi, G Guaraldi, G Nardini, C Stentarelli, B Beghetto, A M Degli Antoni, A Molinari, M P Crisalli, A Donisi, M Piepoli, V Cerri, G Zuccotti, V Giacomet, S Coletto, F Di Nello, C Madia, G Placido, A Vivarelli, P Castelli, F Savalli, V Portelli, F Sabbatini, D Francisci, L Bernini, P Grossi, L Rizzi, G Maso, M Airoud, G Soppelsa, A Meloni, M Dedoni, C Cuboni, F Ortu, P Piano, A Citernesi, I Bordoni Vicini, K Luzi, M Roccio, A Miccolis, A De Gennaro, B Guerra, F Cervi, G Simonazzi, E Margarito, M G Capretti, C Marsico, G Faldella, M Sansone, A Agangi, A Capone, M Maruotti, C Tibaldi, L Trentini, T Todros, I Cetin, T Brambilla, V Savasi, C Personeni, C Giaquinto, M Fiscon, E Rubino, A Bucceri, R Matrone, G Scaravelli, O Genovese, C Cafforio, V Tozzi, P Massetti, A M Casadei, A F Cavaliere, M Cellini, G Castelli Gattinara, A M Marconi, V Sacchi, M Ierardi, C Polizzi, A Mattei, M F Pirillo, R Amici, C M Galluzzo, S Donnini, S Baroncelli, P Villani, M Cusato, A Cerioli, M De Martino, P Mastroiacovo, F Parazzini, S Vella

Affiliations

¹ Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy.
² Department of Infectious Diseases, Catholic University, Rome, Italy.
³ Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital and University of Turin, Turin, Italy.
⁴ Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Italy.
⁵ Department of Obstetrics and Gynaecology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
⁶ INMI Lazzaro Spallanzani, Rome, Italy.
⁷ Department of Obstetrics and Gynaecology, University of Bari, Bari, Italy.
⁸ Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
⁹ Department of Infectious Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy.
¹⁰ Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy.

PMID: 28000379
DOI: 10.1111/hiv.12473

Abstract

Objectives: The aim of the study was to assess the rate, determinants, and outcomes of repeat pregnancies in women with HIV infection.

Methods: Data from a national study of pregnant women with HIV infection were used. Main outcomes were preterm delivery, low birth weight, CD4 cell count and HIV plasma viral load.

Results: The rate of repeat pregnancy among 3007 women was 16.2%. Women with a repeat pregnancy were on average younger than those with a single pregnancy (median age 30 vs. 33 years, respectively), more recently diagnosed with HIV infection (median time since diagnosis 25 vs. 51 months, respectively), and more frequently of foreign origin [odds ratio (OR) 1.36; 95% confidence interval (CI) 1.10-1.68], diagnosed with HIV infection in the current pregnancy (OR: 1.69; 95% CI: 1.35-2.11), and at their first pregnancy (OR: 1.33; 95% CI: 1.06-1.66). In women with sequential pregnancies, compared with the first pregnancy, several outcomes showed a significant improvement in the second pregnancy, with a higher rate of antiretroviral treatment at conception (39.0 vs. 65.4%, respectively), better median maternal weight at the start of pregnancy (60 vs. 61 kg, respectively), a higher rate of end-of-pregnancy undetectable HIV RNA (60.7 vs. 71.6%, respectively), a higher median birth weight (2815 vs. 2885 g, respectively), lower rates of preterm delivery (23.0 vs. 17.7%, respectively) and of low birth weight (23.4 vs. 15.4%, respectively), and a higher median CD4 cell count (+47 cells/μL), with almost no clinical progression to Centers for Disease Control and Prevention stage C (CDC-C) HIV disease (0.3%). The second pregnancy was significantly more likely to end in voluntary termination than the first pregnancy (11.4 vs. 6.1%, respectively).

Conclusions: Younger and foreign women were more likely to have a repeat pregnancy; in women with sequential pregnancies, the second pregnancy was characterized by a significant improvement in several outcomes, suggesting that women with HIV infection who desire multiple children may proceed safely and confidently with subsequent pregnancies.

Keywords: HIV; HIV RNA; birth weight; pregnancy; preterm delivery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anti-HIV Agents / therapeutic use
CD4 Lymphocyte Count
Emigrants and Immigrants
Female
HIV Infections / complications*
HIV Infections / drug therapy*
HIV Infections / immunology
HIV Infections / virology
HIV-1 / physiology
Humans
Infant, Low Birth Weight*
Pregnancy
Premature Birth / epidemiology*
Viral Load

Substances

Anti-HIV Agents