Byrne Laura, Thorne Claire, Foster Caroline, Tookey Pat
Policy and Practice Programme, UCL Institute of Child Health, Population, London, UK.
Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK.
J Int AIDS Soc. 2014 Nov 2;17(4 Suppl 3):19693. doi: 10.7448/IAS.17.4.19693. eCollection 2014.
In the United Kingdom and Ireland more than 40% of individuals living with perinatally acquired HIV are now aged >16. Globally, increasing numbers of women with perinatally acquired HIV are becoming pregnant, but data on fertility and pregnancy outcomes is scarce. We present pregnancy outcome data for this emerging cohort.
Pregnancies in diagnosed HIV-infected women in the United Kingdom and Ireland, and children diagnosed with HIV, are reported to the National Study of HIV in Pregnancy and Childhood. We analyzed data on pregnancies in women diagnosed aged ≤13 with perinatally acquired HIV, reported by June 2014.
A total of 759 females born before 2001, diagnosed with perinatally acquired HIV aged ≤13 years, and in care in the UK and Ireland have been reported. Forty-four of these (6%) have had at least one pregnancy reported, with nineteen 2nd and four 3rd/4th pregnancies. Women's year of birth ranged from 1985 to 1996; 60% of women were UK/Irish-born and 39% African-born. Twenty one percent were diagnosed at <2 years, 39% at 2-7 and 41% at 8-13 years. Nine pregnancies were conceived in 2005-07, 22 in 2008-10 and 36 in 2011-13. Median age at conception of first pregnancy was 19 years. CD4 count was >500 cells/µL in 36% of first pregnancies, 350-499 in 15% and <350 in 49%. Women were on antiretroviral therapy (ART) at conception in 71% of pregnancies. There were 51 singleton live births, 2 miscarriages, 9 terminations and 5 continuing to term. In 17 live births to women not on ART at conception, median gestational age at start of ART was 17 weeks (range 3-29). HIV viral load was <50 copies/mL near delivery in 64% of live births, 51-1000 in 31% and >1000 in 5%. Forty four percent of live births were delivered by elective caesarean section (CS), 27% by emergency CS, 27% by planned vaginal delivery and with one unplanned vaginal delivery. Of 29 live births with viral load <50, 31% were delivered by elective CS, 17% by emergency CS and 52% by vaginal delivery. Fifteen percent of infants were delivered at 32-36 weeks gestation, and 2% at 30 weeks; 16% weighed 1.5-2.5 kg and 16% weighed <1.5 kg. Among 38 of the 51 infants where infection status is already reported, one is perinatally infected.
Currently at least 6% of perinatally infected women in care in the UK and Ireland have experienced one or more pregnancies. Linking paediatric, pregnancy and second generation data will enable further monitoring of pregnancy outcomes in this newly emerging population.
在英国和爱尔兰，超过40%的围产期感染艾滋病毒的个体现在年龄超过16岁。在全球范围内，越来越多围产期感染艾滋病毒的妇女怀孕，但关于生育力和妊娠结局的数据却很匮乏。我们呈现了这一新兴队列的妊娠结局数据。
英国和爱尔兰已确诊感染艾滋病毒的妇女以及被诊断出感染艾滋病毒的儿童的妊娠情况会上报至全国妊娠与儿童期艾滋病毒研究。我们分析了截至2014年6月上报的、出生时即感染艾滋病毒且诊断年龄≤13岁的妇女的妊娠数据。
总共报告了759名2001年以前出生、诊断年龄≤13岁且在英国和爱尔兰接受护理的围产期感染艾滋病毒的女性。其中44名（6%）至少有一次妊娠报告，包括19次二胎妊娠和4次三胎/四胎妊娠。这些女性的出生年份从1985年到1996年不等；60%的女性出生于英国/爱尔兰，39%出生于非洲。21%在2岁前被诊断出感染，39%在2至7岁时被诊断出，41%在8至13岁时被诊断出。9次妊娠发生在2005 - 2007年，22次在2008 - 2010年，36次在2011 - 2013年。首次妊娠时的中位年龄为19岁。在首次妊娠中，36%的女性CD4细胞计数>500个/µL，15%为350 - 499个，49%<350个。71%的妊娠女性在受孕时正在接受抗逆转录病毒治疗（ART）。有51例单胎活产，2例流产，9例终止妊娠，5例持续至足月。在受孕时未接受ART治疗的女性所生的17例活产中，开始ART治疗时的中位孕周为17周（范围3 - 29周）。在活产中，64%的婴儿在临近分娩时艾滋病毒载量<50拷贝/mL，31%为51 - 1000拷贝/mL，5%>1000拷贝/mL。44%的活产通过择期剖宫产（CS）分娩，27%通过急诊CS分娩，27%通过计划阴道分娩，还有1例为非计划阴道分娩。在病毒载量<50的29例活产中，31%通过择期CS分娩，17%通过急诊CS分娩，52%通过阴道分娩。15%的婴儿在妊娠32 - 36周时分娩，2%在30周时分娩；16%的婴儿体重为1.5 - 2.5千克，16%的婴儿体重<1.5千克。在已报告感染状况的51例婴儿中的38例中，有1例为围产期感染。
目前在英国和爱尔兰接受护理的围产期感染艾滋病毒的女性中，至少6%经历过一次或多次妊娠。将儿科、妊娠和第二代数据相联系，将有助于进一步监测这一新兴人群的妊娠结局。
