Most women living with HIV can deliver vaginally — national data from Finland 1993–2013

Abstract Introduction: Vaginal delivery has been recommended for more than ten years for women living with HIV (WLWH) with good virological control. However, in Europe most WLWH still deliver by cesarean section (CS). Our aim was to assess the rate of vaginal delivery and the indications for CS in WLWH over 20 years in a setting of low overall CS rate. Materials and methods: This was a retrospective study of all WLWH delivering in Finland 1993–2013. We identified the women by combining national health registers and extracted data from patient files. Results: The study comprised 212 women with 290 deliveries. Over 35% of the women delivered several children during the study years. During 2000–2013, with consistent viral load monitoring, 80.0% showed HIV viral loads <50 copies/mL in the last measurement preceding the delivery. Altogether 74.5% of all WLWH delivered vaginally and the rate of both elective CS and emergency CS was 12.8% each. For most CSs (63.5%) the indication was obstetrical, for 28.4% it was avoiding HIV transmission and for 0.7% it was mother’s request. In hospitals with less than ten HIV-related deliveries during the study period, the rate of elective CS was higher than in more experienced hospitals (22.7% versus 10.6% [p = 0.024]). No perinatal HIV transmissions occurred. Conclusions: Most WLWH can achieve good virological control and deliver vaginally. This will help them to maintain their future child bearing potential and reduce CS-related morbidity.Members of the FINHIVPREG study team: Inka Aho, Helsinki University Hospital, Helsinki; Sanna Uusitalo, University of Oulu, Oulu; Taru Finnilä, Turku University Hospital, Turku; Hanna Viskari, Tampere University Hospital, Tampere; Pirjo Alho, Kanta-Häme Hospital District, Hämeenlinna; Sari Hämäläinen, Kuopio University Hospital, Kuopio; Tuomas Nieminen, Satakunta Central Hospital, Pori; Elina Kärnä, Seinäjoki Central Hospital, Seinäjoki; Ville Lehtinen, Päijät-Häme Central Hospital, Lahti; Maija Rummukainen, Central Finland Health Care District, Jyväskylä; Antti Väänänen, Lapland Central Hospital, Rovaniemi; Jukka Heikkinen, North Carelia Central Hospital, Joensuu; Risto Pietikäinen, Kymenlaakso Central Hospital, Kotka; Pekka Suomalainen, South Carelia Central Hospital, Lappeenranta; Sakari Vuorinen, Mikkeli Central Hospital, Mikkeli)

A highly virulent variant of HIV-1 circulating in the Netherlands

We discovered a highly virulent variant of subtype-B HIV-1 in the Netherlands. One hundred nine individuals with this variant had a 0.54 to 0.74 log10 increase (i.e., a ~3.5-fold to 5.5-fold increase) in viral load compared with, and exhibited CD4 cell decline twice as fast as, 6604 individuals with other subtype-B strains. Without treatment, advanced HIV-CD4 cell counts below 350 cells per cubic millimeter, with long-term clinical consequences-is expected to be reached, on average, 9 months after diagnosis for individuals in their thirties with this variant. Age, sex, suspected mode of transmission, and place of birth for the aforementioned 109 individuals were typical for HIV-positive people in the Netherlands, which suggests that the increased virulence is attributable to the viral strain. Genetic sequence analysis suggests that this variant arose in the 1990s from de novo mutation, not recombination, with increased transmissibility and an unfamiliar molecular mechanism of virulence