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 pregnant 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 to 69% (327/471) after 1997 while the proportion acquiring HIV through injecting drug use has declined. Overall median CD4 cell count was 440 × 106/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 < 0.002). 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 cell count, risk of vertical transmission was reduced by 66% (95% confidence interval, 37–82%) with the full 076 regimen and by 60% (95% confidence interval, 33–73%) with elective cesarean section delivery.
Conclusions: Changes in treatment of adult HIV disease have affected the management of infected pregnant women. Despite therapeutic and surgical interventions, vertical transmission still occurs.
From the European Collaborative Study and prepared by Claire Thorne, Marie-Louise Newell, Linsay Gray, Simona Fiore and Catherine S. Peckham, Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College, London, UK.
Received: 1 November 2000;
revised: 1 February 2001; accepted: 6 February 2001.
Sponsorship: The European Collaborative Study is a concerted action of the European Commission (Biomed II PL 97 2005). The Medical Research Council (UK) provides support to the co-ordinating centre. Collaborating Centres were supported by grants from the Ministero della Sanita - Istituto Superiore di Sanita, progetto AIDS (Padua, Genoa); the Medical Research Council (UK), the AIDS Virus Education Research Trust, the Scottish Office Home and Health Department (Edinburgh); Praeventiefonds number 28-1704 (Amsterdam); Bundesminister fur Gesundheit (Berlin); Fonds Houtman, Office de la Naissance et de L'Enfance, Communaute Francaise de Belgique (Brussels), and the Swedish Medical Research Council (Stockholm).
Requests for reprints to: M.-L. Newell, Department of Paediatric Epidemiology and Biostatistics, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.