The changing HIV epidemic in Italian pregnant women

Objective: To describe changes in the characteristics of HIV-pregnant women in Italy and the impact of strategies for prevention of HIV vertical trans mission. Study design: Since 1985, HIV-infected women and their children ar e followed in 23 European centres in the European Collaborative Study (ECS) , according to a standard protocol. Eight Italian Obstetric units participa ting in the ECS enrolled 815 patients. Results: Overall use of zidovudine t o reduce HIV vertical transmission has increased significantly since 1994 a nd between 1995 and 1997, 57% of Italian women were treated. However, 27% o f babies received the infant component of the 076 regimen. Over the years, age at delivery has increased and their CD4 count at delivery decreased, mo st likely reflecting heterosexually infected women with a longer duration o f infection. The increasing rate of elective caesarean section (42%) is not related to maternal, foetal or obstetrical indications, but its use as an intervention to reduce HIV vertical transmission. Conclusions: The identifi cation of HIV-infected women during pregnancy or before delivery ensures th e appropriate management of the woman and her child, and clinicians should be aware of the increasing number of women with heterosexual acquisition of HIV-infection who may be less easily identified. (C) 2000 Elsevier Science Ireland Ltd. All rights reserved.