Transcript Treatment and pregnancy outcome in pregnant women with

Treatment and pregnancy outcome in pregnant women with HIV
infection diagnosed through opt-out screening versus patients
engaged in HIV care before conception
N.J.
1
Kleinrensink ,
A.C.C. Van
2
Oppen ,
T. Mudrikova
1
1Dept
of Internal Medicine & Infectious Diseases, 2 Dept of Gynecology and Obstetrics, University
Medical Center Utrecht
Conclusions
Although having got the diagnosis of HIV infection through the opt-out screening program was not associated with
higher proportion of detectable viremia at delivery, emergency caesarean section was necessary in a significantly
higher proportion of these patients when compared with patients with known HIV infection at conception.
Introduction
In 2004, a non-selective opt-out screening program for
human immunodeficiency virus (HIV) in pregnant women
was implemented in the Netherlands. This analysis aimed to
evaluate the efficiency of antiretroviral treatment and
pregnancy outcomes in patients who were diagnosed
through the opt-out program compared to women with
known HIV infection at conception.
Methods
• a single-center retrospective cohort study of pregnant
women in UMC Utrecht between 01-01-2004 and 01-032015
• only first pregnancy after HIV diagnosis included
• possible risk factors for a detectable plasma HIV RNA
viral load (VL) at delivery analyzed using the chi-square or
Fisher’s exact test
• statistically significant risk factors subsequently analyzed
in a multivariate logistic regression analysis
Results
78 pregnancies were included:
• 32 patients diagnosed through opt-out screening (group 1)
• 46 patients had known HIV infection by conception (group 2)
Only baseline VL >100.000 copies/ml was significantly
associated with detectable VL at delivery after multivariate
analysis (see Table 1; P 0.05).
Patients diagnosed with HIV during pregnancy underwent
significantly more emergency caesarean sections than
patients with known HIV infection at conception (50% vs.
19.6%, resp.; P  0.05), mostly due to (suspected) fetal
stress (Table 2).
Discussion
Diagnosis of HIV infection before or during pregnancy was
not associated with detectable VL at delivery, which is in
accordance with a recent U.S. multicenter study1. The
number of emergency caesarean sections was higher in the
opt-out group than expected, based on previous research2 in
HIV-infected pregnant women2.
References
1.Katz IT, Leister E, Kacanek D, et al. Factors Associated With Lack of Viral Suppression at Delivery Among Highly Active Antiretroviral Therapy-Naive Women With HIV: A Cohort Study. Ann Intern Med. 2015;162(2):9099. doi:10.7326/M13-2005.
2.Boer K, Nellen JF, Patel D, et al. The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery. BJOG. 2007;114(2):148-155.
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NCHIV 2015
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