Congenital CMV infection in HIV-infected women on HAART

Background \u2013 The introduction of antiretroviral therapy (ART/HAART) has modified both the natural history of HIV disease and the epidemiology of CMV disease in HIV patients by lowering the rate of CMV reactivation. Anti retroviral therapy is recommended in HIV infected women in order to reduce the risk of vertical transmission of HIV. Objective \u2013 To verify whether ART/HAART can have some preventive effect also on the vertical transmission of CMV Design \u2013 Retrospective survey of congenital CMV infection in a cohort of HIV infected pregnant women on ART/HAART . Materials and methods \u2013 We examined 303 consecutive children born in the years 2000-2005. The mothers received lamivudine plus zidovudine since week 22 (13-38) of pregnancy; from 2003 a protease inhibitor was added to the treatment; their CMV serological status was assessed at first visit, HIV viral load and CD4/CD8 counts were measured at delivery. All newborns were screened for congenital CMV infection by means of viral isolation and/or CMV PCR on saliva samples collected in the first 3 days of life. Urine and PBL of infected babies were examined in the following days and at clinical follow-up visits. Results \u2013 Vertical transmission of CMV occurred in 9 cases (2.97%), HIV was transmitted in two other babies only (0.6%). Four of the CMV infected children were premature, one of them was symptomatic at birth, one developed a monolateral hearing loss at age 4. None of the term babies was symptomatic at birth nor has developed any sequela so far. Only the mother of the symptomatic girl had a positive IgM test, all the other transmitting mothers were IgG+/IgM- in pregnancy. Conclusions \u2013 1)Congenital CMV rate is about 10 times higher than in the open Italian population (0.2%), but lower than the one (5.7%) found in a previous Italian study on babies born to HIV infected mothers; 2) The lower rate of transmission might be due to the reduction of CMV reactivation caused by ART/HAART

Early invasive diagnostic techniques in pregnant women who are infected with the HIV : a multicenter case series

Objective: Studies that mostly were conducted before the widespread use of combination antiretroviral treatments have reported that antenatal invasive procedures markedly increase the risk of human immunodeficiency virus vertical transmission. We aimed to evaluate the vertical transmission rate and other maternal and neonatal complications among women who were infected with human immunodeficiency virus who underwent antenatal invasive procedures during the second trimester of pregnancy and who were delivered after the advent of antiretroviral regimens. Study design: We conducted a multicenter case series of women who were infected with human immunodeficiency virus who underwent amniocentesis or chorionic villus sampling or cordocentesis during the second trimester of pregnancy and who were delivered after January 1, 1997. Results: Sixty-three of 775 recruited women (8.1%) had performed early invasive diagnostic techniques. This rate has improved progressively from 4% in 1997 to 14%. Two of 60 viable infants (3.3%; 95% CI, 0.6%-10.1%) were infected with the human immunodeficiency virus. This rate did not differ significantly from the transmission rate that was observed in women who did not undergo antenatal invasive techniques (1.7%; P = .30). Conclusion: The current risk of human immunodeficiency virus vertical transmission that is associated with early invasive diagnostic techniques is lower than previously reported

Mode of delivery and gestational age influence perinatal HIV-1 transmission. Italian Register for HIV Infection in Children

Some data suggest that cesarean section reduces mother-to-child HIV-1 transmission. To assess the influence of mode of delivery and other maternal and infant factors on the rate of transmission, we analyzed the data of 1,624 children prospectively followed from birth. Of these, at the last visit 1,033 were > 18 months of age or would have been had they not died of HIV-related illness. Among the 975 first singleton children, 180 [18.5%; 95% confidence limits (CL), 16.1-20.9] acquired infection, as did 8 of 56 (14.3%; 95% CL, 5.1-23.5) second-born children. Multivariate stepwise analysis showed that vaginal delivery and development of symptoms in the mother were significantly and independently associated with a higher transmission rate (vaginal delivery; odds ratio, 1.69; 95% CL, 1.14-2.5; symptoms: odds ratio, 1.61; 95% CL, 1.12-2.3). In contrast, a history of maternal drug use, birth weight, breast-feeding (only 37 infants were breast-fed), and child's sex did not have a significant impact on viral transmission. The percentage of infected children was highest (30.7%) among very premature infants (< or = 32 weeks of gestation); this significant trend subsequently decreased to 11.9% at the week 42 (p < 0.001), suggesting a parallel reduction in peripartum transmission. The reduced rate of infection observed in infants born by cesarean section underlines the urgent need for randomized controlled trials to evaluate the protective role of surgical delivery in preventing perinatal HIV-1 transmissio

Good prenatal detection rate of major birth defects in HIV-infected pregnant women in Italy

What's already known about this topic? Exposure to antiretroviral treatment in pregnancy does not seem to increase the risk of birth defects, but there is no information on the rate of prenatal detection of such defects. What does this study adds? We provide for the first time, in a national case series, information about prenatal detection rate in women with HIV (51.6% for any major defect, 66.7% for chromosomal abnormalities, and 85% for severe structural defects)