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- W2068488981 abstract "Purpose of the study The aim of this study was to describe trends in the management of pregnancies in HIV-infected women and their outcomes, over a 4-year period in Latvia on an Infectology Center of Latvia (LIC) basis. Methods The study of HIV-infected women in Latvia giving birth to one or more children between 1 Jan 2008 and 31 Dec 2011. Results We identified 199 HIV-infected women with 210 pregnancies. Mean age was 27 years, median baseline pregnancy CD4 count was 452 cells/mm3, the baseline pregnancy plasma viral load (VL) was 53,066 copies/ml. Knowledge of HIV status before pregnancy was 60.5%, but 32.5% HIV-positive diagnosis was confirmed during pregnancy and 7.1% after delivery. One pregnant woman's HIV disease progressed to AIDS and death. Women on antiretroviral therapy (ART) were 82.3%. Maternal monotherapy with the zidovudine (ZDV) rate was 10.4%, dual therapy with nucleoside reverse-transcriptase inhibitor (NRTI) - 2.3%, triple therapy with the protease-inhibitor (PI) plus NRTI - 87.3%. Median VL at delivery was 1349. A greater proportion of cases 91.5% had a VL <1000 copies/ml, from them 47.4% <40 copies/ml. Vaginal deliveries range was 20.8% of pregnancies and elective cesarean delivery 68.6%. Preterm delivery occurred in 12.1%. Overall mother-to-child transmission (MTCT) of HIV rate was 4.3%. Among the 35.5% of mothers initiating ART at 14 weeks’ gestation, MTCT was 1.4%, compared with 1.5% and 3.1% for those initiating ART at <14 weeks (n=67, 31.9%) and >24 weeks (n=32, 15.2%). Among 17.6% women, who did not receive prophylactic ART, MTCT rate was 16.2%. 7 of 9 women giving birth to an HIV-positive child were diagnosed with HIV before pregnancy, 1 of 9 during pregnancy, 1 of 9 after delivery. From women giving birth to an HIV-positive child 6 did not receive prophylactic ART, 1 started ART at week 14, 2 after week 14. Conclusions Women's low education, recurrent pregnancies, intravenous drug use, vaginal deliveries, not receiving and late initiation of prophylactic ART was independently (p<0.05) associated with an increased risk of MTCT. Strategies are needed to facilitate earlier identification of HIV- infected women (also HIV status identification twice during pregnancy). Management of pregnancies in HIV-infected women according to the LIC guidelines, i.e. ART from week 14, intravenous ZDV during labour, elective cesarean delivery, neonatal ZDV during 6 weeks and no breastfeeding is effective to reduce risk for MTCT." @default.
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- W2068488981 date "2012-11-11" @default.
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- W2068488981 title "Prevention of mother-to-child transmission of HIV in Latvia, 2008–2011" @default.
- W2068488981 doi "https://doi.org/10.7448/ias.15.6.18256" @default.
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