Servicio de Pediatría, Hospital Universitario de Navarra, Pamplona, Spain.
Servicio de Pediatría, Hospital Universitario 12 de Octubre e Instituto de Investigación I+12, Madrid, Spain.
J Acquir Immune Defic Syndr. 2022 Dec 1;91(4):373-380. doi: 10.1097/QAI.0000000000003070. Epub 2022 Oct 10.
An increasing number of women living with perinatally acquired HIV are reaching adulthood and becoming pregnant. Achieving viral suppression is challenging in this population frequently exposed to numerous antiretroviral regimens. This study describes the long-term outcomes of pregnant women living with perinatally acquired HIV in Spain.
Descriptive, retrospective, multicenter study of the women living with perinatally acquired HIV who gave birth between January 2000 and December 2019 in Madrid. Epidemiological, clinical, and HIV-related data were collected from the first delivery to the end of the study period, including antiretroviral therapy, prevention strategies, and outcomes.
Sixty-three live births in 33 women were included. The mean number of pregnancies per women was 1.9 (range: 1-6). At first delivery, women's median age was 20 years (interquartile range: 18-23), 11 (33.3%) had been previously diagnosed with AIDS and 6 (18%) with mental health disorders. Forty percent became pregnant unsuppressed, whereas 81% achieved viral suppression at delivery. Treatment interruptions were common after delivery, as were losses to follow-up, with no positive effect of pregnancy on retention to care or the immune virological situation. Five women (15%) experienced a new AIDS event, and there were 2 deaths (6%) during follow-up. There was 1 case of mother-to-child transmission in a nonadherent woman in whom preventive measures could not be implemented.
Pregnancy in this unique population of women living with perinatally acquired HIV poses particular challenges. Specific strategies, including a multidisciplinary approach, are needed to minimize perinatal transmission risks and improve outcomes during the postpartum period.
越来越多的母婴传播 HIV 感染者已进入成年并怀孕。由于该人群频繁接触多种抗逆转录病毒治疗方案，实现病毒抑制具有挑战性。本研究描述了西班牙母婴传播 HIV 感染者孕妇的长期结局。
对 2000 年 1 月至 2019 年 12 月期间在马德里分娩的母婴传播 HIV 感染者孕妇进行描述性、回顾性、多中心研究。从首次分娩到研究结束，收集了流行病学、临床和与 HIV 相关的数据，包括抗逆转录病毒治疗、预防策略和结局。
共纳入 33 名妇女的 63 例活产。每名妇女的平均妊娠次数为 1.9（范围：1-6）。首次分娩时，妇女的中位年龄为 20 岁（四分位距：18-23），11 名（33.3%）曾被诊断为艾滋病，6 名（18%）患有精神健康障碍。40%的孕妇未得到抑制，而 81%的孕妇在分娩时实现了病毒抑制。产后中断治疗和失访很常见，怀孕对保留在医疗保健系统或免疫病毒学状况无积极影响。5 名妇女（15%）出现新的艾滋病事件，随访期间有 2 人死亡（6%）。1 例未遵医嘱的母婴传播事件发生在一名孕妇中，未能实施预防措施。
母婴传播 HIV 感染者孕妇面临特殊挑战。需要特定策略，包括多学科方法，以最大限度地降低围产期传播风险，并改善产后期间的结局。
