Evolving Characteristics of HIV Infected Pregnancies at a Single Institution
Cooper, Sara J.
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OBJECTIVE: Over the past 26 years, significant advances have been made in the understanding and management of patients infected with HIV. We sought to determine if these changes in HIV care have had an impact on the characteristics of pregnant women with HIV and their pregnancies in a large cohort of HIV infected women at a single institution. STUDY DESIGN: This was a retrospective review of all pregnancies infected with HIV who presented for prenatal care at our institution from January 1986 through November 2012. Medical records were reviewed, and maternal, neonatal, and delivery data were ascertained. The data were divided into three cohorts representing different levels of antiretroviral therapy and analyzed for trends. Cohort 1 (pre-HIV interventions) includes data from 1986-1991, Cohort 2 (introduction of ZDV) includes data from 1992-2002, and Cohort 3 (multi-drug therapy) comprises the remaining data from 2003-2012. RESULTS: During the 26 year study period 1005 HIV infected pregnancies were identified. The incidence of HIV in pregnancy has remained stable at 0.2 -0.3% of all deliveries. The vast majority of our HIV infected obstetric population receives prenatal care and the number of patients receiving no prenatal care has decreased over time (27% to 6%, p<0.001). There has been a significant increase in maternal age and number of prenatal visits during the study period. The estimated gestational age at delivery has remained steady throughout the entire data set and there have been no changes in birthweight, 5-minute APGAR <7, prematurity, stillbirth, or neonatal deaths. The rate of cesarean section doubled (24% to 55%, p<0.001) for deliveries after 2000 following the release of guidelines recommending scheduled c-section for patients with viral loads >1000 copies/mL. Median maternal viral load and CD4 count have not changed significantly throughout the cohorts, with HIV viral load usually becoming non-detectable by delivery. CONCLUSION: Over the past two decades, HIV infected women have presented for prenatal care at an older age, entered prenatal care earlier with more frequent visits and overall have decreased maternal viral copy number at delivery with antiretroviral therapy. Despite increased maternal age, pregnancy outcomes remain excellent. This study highlights the fact that appropriate prenatal care is associated with excellent pregnancy outcome in this high risk population.