HIV-infected pregnant women and vertical transmission in Europe since 1986

Objective: To describe changes over a 15-year period in characteristics and management of HIV-infected pregnant women in Europe. Design: Prospective study. Methods: Analysis of prospective data on 2876 pr egnant HIV-infected women and their 3076 infants. Factors examined included maternal socio-demographic, immunological and virological characteristics, antiretroviral therapy and pregnancy outcome. Results: Among women enrolled, the proportion with heterosexual acquisition of infection has increased significantly from 59% (201/342) in 1985-1987 t o 69% (327/ 471) after 1997 while the proportion acquiring HIV through inje cting drug use has declined. Overall median CD4 cell count was 440 x 10(6)/ l and 41% of women had undetectable viral load at delivery. In 1995 28% (72 /256) of mother-child pairs received the full 076 regimen to reduce risk of vertical transmission, rising significantly to 89% (116/130) by 1999. Use of triple therapy started in pregnancy has increased significantly from (1% 1/153) in 1997 to 44% (47/107) in 1999. Exposure to antiretroviral therapy was not associated with prevalence or pattern of congenital abnormalities (P = 0.88) but was associated with reversible anaemia in the infant (P<0.00 2). The elective cesarean section rate has increased from 10% in 1992 to 71 % in 1999/2000. The vertical transmission rate declined from 15.5% by 1994 to 2.6% after 1998. In multivariate analysis, adjusting for maternal CD4 ce ll count, risk of vertical transmission was reduced by 66% (95% confidence interval, 37-82%) with the full 076 regimen and by 60% (95% confidence inte rval, 33-73%) with elective cesarean section delivery. Conclusions: Changes in treatment of adult HIV disease have affected the ma nagement of infected pregnant women. Despite therapeutic and surgical inter ventions, vertical transmission still occurs. (C) 2001 Lippincott Williams & Wilkins.