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Pregnancies Among the First Generation of Survivors of Perinatal HIV Infection

Published:December 24, 2019DOI:https://doi.org/10.1016/j.jogc.2019.09.022

      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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