Journal Article

P-53 Pregnancy and birth outcomes in women living with HIV: real-life experience

Ierardi, M, Simonetti, SC, Dalzero, S, Mazzoccoli, M, Marconi, AM, Alfieri, N, Bini, T, Marchetti, GC, Tincati, C, Bai, F

2024

Overview

BackgroundApproximately 1.3 million women living with HIV (WLWH) become pregnant each year. Despite advancements in antiretroviral therapy (ART) there remains a paucity of data on the efficacy and safety of ART in pregnancy and birth outcomes.Material and MethodsThis is a retrospective case record analysis of 31 WLWH delivering 33 pregnancies between 2019 and 2023, followed at San Paolo Hospital, Milan. Effect of use of ART during pregnancy, preterm birth (PTB), intrauterine growth restriction (IUGR) and birth outcomes, were analysed. Data were retrieved from medical records and presented descriptively.ResultsThe median age of the women was 36 years (IQR 33;38). Among 33 pregnancies, 7(21%) occurred in newly diagnosed HIV women, while 26(79%) occurred in women in active follow-up. 5(71%) of newly diagnosed women initiated ART during the first trimester, with all regimens being INSTI-based. In experienced patients, at the time of discovering the pregnancy, 16(61%) were on an INSTI-based regimen, 6(24%) were on therapy with PI, and 4 (15%) were on NNRTI therapy. 6 patients (23%) changed their ART regimen to an INSTI-based therapy (table 1). Viremia was undetectable at delivery in all patients except one who was non-adherent to therapy (HIV-RNA 69 copies/mL). Both treatment-naive and experienced patients began pregnancy with favorable CD4 counts (median CD4+ 676 cells/uL, IQR 476;778) that remained stable throughout gestation. In most patients, pregnancy occurred spontaneously, with only 1 patient resorting to assisted reproductive technology (ART). Regarding pregnancy outcome, 22(67%) of the patients delivered. In the remaining cases, pregnancy resulted in an abortion, a voluntary termination and 4 patients (12%) were lost to follow-up. 91% of the newborns were delivered at term. 13(59%) patients had a vaginal delivery and 9(41%) had a cesarean section: only in one case the indication for cesarean section was due to detectable viremia. At the third-trimester ultrasound, 91% of the babies had a EFW (estimated fetal weight) percentile above the 50th (median 55th percentile, IQR 50;70). Regarding the newborns, 99% had a normal birth weight with a median birth weight of 3230 g (IQR 2973;3485). All newborn received ZDV prophylaxis for 6 weeks and no one was breastfed. All newborns tested negative for HIV-RNA.ConclusionIn our cohort, all women except one achieved undetectable viremia prior to delivery, and no adverse birth outcomes such as low birth weight or preterm delivery were observed. However, a relatively high proportion of women (all foreigners) was lost to follow-up, underscoring the importance of monitoring and support for the optimization of care in WLWH during pregnancy and beyond. Viral suppression should be prioritized in all pregnant women with HIV to prevent both vertical transmission and adverse birth outcome.Abstract P-53 Table 1Demographic profile and ART regimen in pregnant WLHW

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Antiretroviral drugs / Birth weight / Cesarean section / HIV / Human immunodeficiency virus / Pregnancy