Management and Outcome of Pregnant Women with HIV Acquired by Vertical Transmission

Abstract

Brief Introduction: Combined antiretroviral therapy for perinatally HIVacquiredchildren has prolonged their survival. The first case of pregnancy in an adolescent with perinatally acquiredhuman immunodeficiency virus was published in 1998. Nowadays, the number of cases of these patients are increasing, so the control of these pregnancies is a new achievement for obstetricians. We don't know the perinatal and long-termmaternal outcomes, because the number of cases is still not enough. Materials & Methods: We report eight patients (nine pregnancies) with HIV acquired by vertical transmission, whose pregnancies were controlled in our tertiary Hospital. They delivered a total of nine newborns between 2004 and 2011. Clinical Cases or Summary Results: The average age of women was 20 years (range 16-26). Seven patients were in their first pregnancy (87.5%). Only one was her second pregnancy. Seven pregnancies were single and one was twin. One suffered an miscarring and one a volunteer pregnancy interruption. All patientstook the treatment during pregnancy, at least at the end of it. One pregnant underwent a pneumonia, which was successfully solved. One pregnancy was a dichorionic twin with small for gestational age fetuses, the remainder were uncomplicated pregnancies. At 36 weeks of gestation, 4 cases had viral load 51000 copies/ml (50%) and the other pregnant had a viral load 41000 copies/ml.All pregnancies were delivered by cesarean section and only two of them were urgent. The average of term was 36 weeks (33 + 3;38 + 2), 4 of them were before 37 weeks (40%) and the average weight was 2212,777 gr (1820;3325). In any case mother-to-child transmission was reported (We lack the viral load of the last two infants). Conclusions: The management of pregnant women with HIV acquired by vertical transmission is difficult, because these women are teenager and young. In addition, combined antiretroviral therapy during pregnancy should be a strict treatment in order to achieve the maximal viral suppressionat the moment of the delivery, and the most cases, the compliance of the treatment use to be poor (In our experience, the 50%).