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Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital: a 30-year retrospective study

  • S. GRIGNOLO (a1), R. AGNELLO (a2), D. GERBALDO (a2), C. GOTTA (a3), C. ALICINO (a4), F. DEL PUENTE (a1), L. TARAMASSO (a1), B. BRUZZONE (a5), C. GUSTAVINO (a2), S. TRASINO (a3), A. DE MARIA (a1), G. ICARDI (a4), C. VISCOLI (a1) and A. DI BIAGIO (a1)...

The primary study objective was to investigate three decades from 1985 to 2014 of changes in pregnancies among HIV-infected women. The secondary objective was to assess risk factors associated with preterm delivery and severe small-for-gestational-age (SGA) infants in HIV-infected women. A retrospective review of deliveries among pregnant HIV-infected women at the University of Genoa and IRCCS San Martino-IST in Genoa between 1985 and 2014 was performed. Univariate and multivariable analyses were used to study the variables associated with neonatal outcomes. Overall, 262 deliveries were included in the study. An increase in median age (26 years in 1985–1994 vs. 34 years in 2005–2014), in the proportion of foreigners (none in 1985–1994 vs. 27/70 (38·6%) in 2005–2014), and a decrease in intravenous drug use (75·2% (91/121) in 1985–1994 vs. 12·9% (9/70) in 2005–2014) among pregnant HIV-infected women was observed. Progressively, HIV infections were diagnosed sooner (prior to pregnancy in 80% (56/70) of women in the last decade). An increase in combined antiretroviral therapy (cART) prescription during pregnancy (50% (27/54) in 1995–2004 vs. 92·2% (59/64) in 2005–2014) and in HIV-RNA <50 copies/ml at delivery (19·2% (5/26) in 1995–2004 vs. 82·3% (53/64) in 2005–2014) was observed. The rate of elective caesarean section from 1985 to 1994 was 9·1%, which increased to 92·3% from 2004 to 2015. Twelve (10·1%) mother-to-child transmissions (MTCT) occurred in the first decade, and six (8·3%) cases occurred in the second decade, the last of which was in 2000. Preterm delivery (<37 weeks gestation) was 5% (6/121) from 1985 to 1994 and increased to 17·1% (12/70) from 2005 to 2014. In univariate and multivariable logistic regression analyses, advancing maternal age and previous pregnancies were associated with preterm delivery (odds ratio (OR) 2·7; 95% confidence intervals (CI) 1–7·8 and OR 2·6; 95% CI 1·1–6·7, respectively). In the logistic regression analysis, use of heroin or methadone was found to be the only risk factor for severe SGA (OR 3·1; 95% CI 1·4–6·8). In conclusion, significant changes in demographic, clinical and therapeutic characteristics of HIV-infected pregnant women have occurred over the last 30 years. Since 2000, MTCT has decreased to zero. An increased risk of preterm delivery was found to be associated with advancing maternal age and previous pregnancies but not with cART. The use of heroin or methadone has been confirmed as a risk factor associated with severe SGA.

Corresponding author
*Authors for correspondence: S. Grignolo, Infectious Diseases Unit, IRCCS AOU San Martino – IST, University of Genoa, L.go R. Benzi 10, 16132, Genoa, Italy. (Email:
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SG and RA contributed equally in the paper.

Members of the Genova HIV Neonatal and Pregnancy Working Group are listed in the acknowledgment section.

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1. World Health Organization. Programmatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. ( Accessed 13 May 2016.
2. Centers for Disease Control and Prevention. Enhanced perinatal surveillance—15 areas, 2005–2008. HIV Surveillance Supplemental Report 2011; 16(2). ( Accessed 11 November 2016.
3. Townsend, CL, et al. Earlier initiation of ART and further decline in mother-to-child HIV transmission rates, 2000–2011. AIDS 2014; 28: 10491057.
4. Istituto Superiore di Sanità. Dati HIV AIDS - Notiziario Istituto Superiore di Sanità (ISS) 2015; 28(9), Supplement 1. ( Accessed 18 March 2016.
5. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. ( Accessed 28 March 2016.
6. Watts, DH, et al. Complications according to mode of delivery among human immunodeficiency virus-infected women with CD4 lymphocyte counts of < or = 500/microL. American Journal of Obstetrics & Gynecology 2000; 183: 100107.
7. Bulterys, M, et al. Sexual behavior and injection drug use during pregnancy and vertical transmission of HIV-1. Journal of Acquired Immune Deficiency Syndromes 1997; 15: 7682.
8. EUROSTAT news release 15 May 2015; International day of families. Women in EU gave birth to their first child at almost 29 years of age on average. ( Accessed 07 November 2016.
9. European Collaborative Study. HIV-infected pregnant women and vertical transmission in Europe since 1986. AIDS 2001; 15: 761770.
10. EACS. European AIDS Clinical Society Guidelines Version 8.0 October 2015. ( Accessed 18 March 2016.
11. Società Italiana di Malattie Infettive e Tropicali (SIMIT). Linee Guida Italiane sull'utilizzo dei farmaci antiretrovirali e sulla gestione diagnostico-clinica delle persone con infezione da HIV-1, 2016 ( Accessed 3 January 2017.
12. Vayssière, C, et al. Fetal growth restriction and intra-uterine growth restriction: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. European Journal of Obstetrics & Gynecology and Reproductive Biology 2015; 193: 1018.
13. Unterscheider, J, et al. Optimizing the definition of intrauterine growth restriction: the multicenter prospective PORTO Study. American Journal of Obstetrics and Gynecology 2013; 208: 290. e1–6.
14. Bruzzone, B, et al. Impact of extensive HIV-1 variability on molecular diagnosis in the Congo basin. Journal of Clinical Virology 2010; 47: 372375.
15. Agresti, A. An Introduction to Categorical Data Analysis, 2nd edn. Hoboken: John Wiley & Sons, 2007, pp. 357.
16. Fay, MP, Proschan, MA. Wilcoxon-Mann-Whitney or t-test? On assumptions for hypothesis tests and multiple interpretations of decision rules. Statistics Surveys 2010; 4: 139.
17. Peters, L, Klein, MB. Epidemiology of hepatitis C virus in HIV-infected patients. Current Opinion in HIV and AIDS 2015; 10: 297302.
18. Townsend, CL, et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS 2008; 22: 973981.
19. Liuzzi, G, et al. Pregnancy outcomes in HIV-infected women of advanced maternal age. HIV Clinical Trials 2013; 14: 110119.
20. Aebi-Popp, K, et al. Missed opportunities among HIV-positive women to control viral replication during pregnancy and to have a vaginal delivery. Journal of Acquired Immune Deficiency Syndromes 2013; 64: 5865.
21. Huntington, SE, et al. Predictors of pregnancy and changes in pregnancy incidence among HIV positive women accessing HIV clinical care at 13 large UK clinics. AIDS 2013; 27: 95103.
22. Report ISTAT. Gravidanza, parto e allattamento al seno. Istituto Nazionale di Statistica (ISTAT) 2013. ( Accessed 18 March 2016.
23. Aebi-Popp, K, et al. National Guidelines for the prevention of mother-to-child transmission of HIV across Europe - how do countries differ? European Journal of Public Health 2013; 23: 10531058.
24. Kind, C, et al. Prevention of vertical HIV transmission: additive protective effect of elective Cesarean section and zidovudine prophylaxis. Swiss Neonatal HIV Study Group. AIDS 1998; 12: 205210.
25. The International Perinatal HIV Group. The mode of delivery and the risk of vertical transmission of human immunodeficiency virus type 1—a meta-analysis of 15 prospective cohort studies. New England Journal of Medicine 1999; 340: 977987.
26. Duong, T, et al. Vertical transmission rates for HIV in the British Isles: estimates based on surveillance data. British Medical Journal 1999; 319: 12271229.
27. European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clinical Infectious Diseases 2005; 40: 458465.
28. Connor, EM, et al. Reduction of maternal–infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. New England Journal of Medicine 1994; 331: 11731180.
29. Lorenzi, P, et al. Antiretroviral therapies in pregnancy: maternal, fetal and neonatal effects. Swiss HIV Cohort Study, the Swiss Collaborative HIV and Pregnancy Study, and the Swiss Neonatal HIV Study. AIDS 1998; 12: F241F247.
30. Townsend, CL, et al. Antiretroviral therapy and premature delivery in diagnosed HIV-infected women in the United Kingdom and Ireland. AIDS 2007; 21: 10191026.
31. Cotter, AM, et al. Is antiretroviral therapy during pregnancy associated with an increased risk of preterm delivery, low birth weight, or stillbirth? The Journal of Infectious Diseases 2006; 193: 11951201.
32. Kourtis, AP, et al. Use of antiretroviral therapy in pregnant HIV-infected women and the risk of premature delivery: a meta-analysis. AIDS 2007; 21: 607615.
33. Fowler, MG, et al. Benefits and risks of antiretroviral therapy for perinatal HIV prevention. New England Journal Medicine 2016; 375: 17261737.
34. European Collaborative Study. Exposure to antiretroviral therapy in utero or early life: the health of uninfected children born to HIV-infected women. Journal of Acquired Immune Deficiency Syndromes 2003; 32: 380387.
35. Hoffman, MC, et al. Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. American Journal of Obstetrics & Gynecology 2007; 196: e11–13.
36. Tuomala, RE, et al. Antiretroviral therapy during pregnancy and the risk of an adverse outcome. New England Journal of Medicine 2002; 346: 18631870.
37. Pritham, UA, Troese, M, Stetson, A. Methadone and buprenorphine treatment during pregnancy. What are the effects? Nursing for Women's Health 2007; 11: 558567.
38. Mozurkewich, EL, Rayburn, WF. Buprenorphine and methadone for opioid addiction during pregnancy. Obstetrics and Gynecology Clinics of North America 2014; 41: 241253.
39. Kakko, J, Heilig, M, Sarman, I. Buprenorphine and methadone treatment of opiate dependence during pregnancy: comparison of fetal growth and neonatal outcomes in two consecutive case series. Drug and Alcohol Dependence 2008; 96: 6978.
40. Brogly, SB, et al. Prenatal buprenorphine versus methadone exposure and neonatal outcomes: systematic review and meta-analysis. American Journal of Epidemiology 2014; 180: 673686.
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