Abstract
Objective
Little is known about pregnancy outcomes among women who have acquired human immunodeficiency
virus (HIV) through perinatal infection and survived into adulthood. The objectives
of this study were to describe pregnancy outcomes among women with perinatal HIV infection
(PHIV) in Canada and to identify potential challenges in the prevention of perinatal
HIV transmission in this population.
Methods
A retrospective review of all pregnancies among women with PHIV who were previously
followed as children at two tertiary care centres in Montréal, Québec, was conducted.
Data were extracted from pediatric and obstetrical records.
Results
There were 21 pregnancies among 11 women, and 18 of these pregnancies were unintentional.
Mean age at first pregnancy was 19.5 years (range 15–29 years). At the first prenatal
visit, 79% had a detectable viral load, 36% were immunosuppressed (CD4 T cell count
<200 mm3), and only 36% were receiving antiretroviral therapy (ART). At the time of delivery,
although all were prescribed ART, 50% of these women still had a detectable viral
load, and 36% remained immunosuppressed. All of the women harboured mutations conferring
drug resistance to zidovudine and lamivudine, and the majority (73%) were also resistant
to nevirapine. None of the infants were HIV infected, although all received prophylaxis
with agents to which their mother's virus was resistant.
Conclusion
Unplanned pregnancies, difficulties with adherence to ART, and drug resistance were
identified challenges in the management of pregnancies among women with PHIV. This
study highlights a gap in the reproductive counselling of adolescents with PHIV and
the need for close follow-up and adherence support during pregnancy in this population.
Résumé
Objectif
Il existe peu de données sur les issues de grossesse chez les femmes qui ont contracté
le virus de l'immunodéficience humaine (VIH) par infection périnatale et qui ont atteint
l'âge adulte. Les objectifs de cette étude consistaient à décrire les issues de grossesse
chez les femmes ayant contracté une infection périnatale au VIH (IPVIH) au Canada
et à déterminer les difficultés potentielles relativement à la prévention de la transmission
périnatale du VIH au sein de cette population.
Méthodologie
Les auteurs ont réalisé une étude rétrospective de toutes les grossesses chez les
femmes ayant contracté une IPVIH qui étaient auparavant suivies durant leur enfance
dans deux centres de soins tertiaires à Montréal, au Québec. Les données ont été extraites
des dossiers pédiatriques et obstétricaux.
Résultats
Il y a eu 21 grossesses parmi un groupe de 11 femmes; de ce nombre, 18 étaient imprévues.
L'âge moyen à la première grossesse était de 19,5 ans (plage de 15 à 29 ans). Lors
de la première visite prénatale, 79 % des femmes présentaient une charge virale détectable,
36 % étaient immunodéficientes (taux de lymphocytes T CD4 < 200 mm3) et seulement 36 % d'entre elles recevaient un traitement antirétroviral (ARV). Au
moment de l'accouchement, même si on leur avait toutes prescrit un traitement ARV,
50 % d'entre elles avaient toujours une charge virale détectable et 36 % sont demeurées
immunodéficientes. Toutes les femmes présentaient des mutations leur conférant une
pharmacorésistance à la zidovudine et à la lamivudine, et la majorité (73 %) éprouvaient
également une résistance à la névirapine. Aucun des nourrissons n'a été infecté par
le VIH, bien qu'ils aient tous reçu des agents prophylactiques auxquels le virus maternel
était résistant.
Conclusion
Les grossesses non planifiées, les difficultés d'adhésion au traitement ARV et la
pharmacorésistance se sont révélées comme difficultés de prise en charge des grossesses
chez les femmes ayant contracté une IPVIH. Cette étude fait ressortir une lacune dans
l'accompagnement relatif à la procréation chez les adolescentes atteintes d'une IPVIH.
Elle souligne aussi le besoin d'assurer un suivi étroit et d'offrir du soutien à l'adhésion
thérapeutique pendant la grossesse auprès de cette population.
Key Words
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Article info
Publication history
Published online: December 24, 2019
Footnotes
This work has been presented in part at the following scientific conferences: International AIDS Conference (AIDS), July 2018, Amsterdam, the Netherlands (poster presentation, THPEB137); and International Congress of Pediatrics (IPA), August 2016, Vancouver, British Columbia (oral abstract presentation).
Competing interests: See Acknowledgements.
The authors have indicated that they meet the journal's requirements for authorship.
Identification
Copyright
© 2019 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
