Pregnancy and neonatal outcomes of perinatally-infected HIV adolescents and young adults
Objective: Children with perinatally-acquired HIV are now reaching child-bearing age and their pregnancies pose specific challenges. Our objective is to review medical and obstetric complications of perinatally-infected adolescents at our institution.
Methods: This is a retrospective chart review at University Hospital, Newark, New Jersey from 1997 to 2007. Demographic information, treatment regimens, medical comorbidities, pregnancy complications and neonatal HIV status were collected.
Results: Within the study period, 10 perinatally-infected adolescents (two patients with two pregnancies) received prenatal care at our institution. Median age at first delivery was 18.5 years (range 16-21). Race/ethnicity was African-American(7), Hispanic(2), and Caucasian(1). Six patients had been previously exposed to 4 or more antiretrovirals, and three had documented resistance. Medical comorbidities included hypertension(1), pulmonary disease(5), hematologic abnormalities(7), cervical dysplasia/sexually transmitted infections(STI)(8) and wasting syndrome(3). Initial viral load (copies/mL) was <400 in three patients, median 8094 (range: <400 - >750,000). Median initial CD4 count was 298 (range: 2 – 858). Ten received HAART, one received combination therapy, and one refused ART. Patients reported adherence in 50% of pregnancies. Median gestational age at delivery was 38 weeks (range: 33-41). At delivery, median viral load and CD4 count was 3152 (range: <400 – 48,042) and 321 (range 29 -605), respectively. Obstetric complications included preterm labor/premature rupture of membranes(2), fetal growth restriction (1), gestational diabetes(1), preeclampsia (3) and oligohydramnios(1). Eight were delivered by cesarean section, with HIV as the indication for 6. Eight neonates were HIV negative, 1 was positive, and 3 are pending.
Conclusions: In spite of their medical comorbidities, pregnancies in perinatally-infected adolescents can have good outcomes. This population is antiretroviral-experienced, so careful selection of treatment regimen is necessary for adequate viral suppression. Antenatal and preconceptional counseling should be directed towards STI prevention and adherence to reduce viral load and thereby reduce HIV-indicated cesarean sections.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
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Pregnancy and neonatal outcomes of perinatally-infected HIV adolescents and young adults.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention: