Multiple pregnancies a safe option for women with HIV

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HIV-positive women can have sequential pregnancies without risking either their own health or that of their infants, Irish investigators have reported at the 12th European AIDS Conference in Cologne.

A review of pregnancies in Dublin showed that use of short-term antiretroviral therapy during pregnancy did not lead to maternal drug resistance. Furthermore, the rate of mother-to-child transmission was low regardless of whether a woman had only one pregnancy or two or more pregnancies and could almost always be attributed to late presentation for care.

Thanks to effective antiretroviral therapy most people with HIV can look forward to a long and healthy life. Not only can treatment with anti-HIV drugs extend the prognosis of HIV-infected individuals, but it can also prevent mother-to-child transmission of HIV. Many HIV-infected women are therefore having one or more pregnancies.

Glossary

vertical transmission

Transmission of an infection from mother-to-baby, during pregnancy, childbirth, or breastfeeding.

 

mother-to-child transmission (MTCT)

Transmission of HIV from a mother to her unborn child in the womb or during birth, or to infants via breast milk. Also known as vertical transmission.

prognosis

The prospect of survival and/or recovery from a disease as anticipated from the usual course of that disease or indicated by the characteristics of the patient.

drug resistance

A drug-resistant HIV strain is one which is less susceptible to the effects of one or more anti-HIV drugs because of an accumulation of HIV mutations in its genotype. Resistance can be the result of a poor adherence to treatment or of transmission of an already resistant virus.

However, little is known about the safety and effectiveness of antiretroviral therapy when it is used during sequential pregnancies. Short-term use of anti-HIV drugs during pregnancy to prevent vertical transmission could, it has been suggested, increase the risk of a mother developing resistance to antiretroviral drugs.

To gain a better understanding of these issues, investigators in Dublin therefore identified all HIV-positive women who had two or more viable pregnancies between 1998 and 2008.

A total of 112 women who had had 263 pregnancies were included in their analysis. Most of these women had two pregnancies, although one individual had five.

Most of the women 63 (70%) took a short course of antiretroviral therapy during pregnancy. Median viral load at the time of delivery regardless of the number of pregnancies was 50 copies/ml, and the majority of women had an undetectable viral load.

Results of resistance tests were available for 39 women. These showed that five had resistance to one or more antiretroviral drug.

The investigators compared the characteristics of the infants born to mother who had multiple pregnancies and those who had only one.

This showed that there was no difference in the gestation, prematurity, birth weight, or the rate of HIV transmission.

A total of three infants (1%) of the infants of mothers having multiple pregnancies were HIV infected compared to transmission rate of 1.5% when a mother only had a single pregnancy. Late presentation for HIV care explained most of these transmissions.

“In this cohort, sequential pregnancies were not associated with an increased risk of vertical transmission”, concluded the investigators.

References

Surah S et al. Sequential pregnancies in HIV infected women. 12th European AIDS Conference, Cologne, abstract PS 9/1, 2009.