Aebi-Popp, K

Bertisch, B

de Tejada, MB

Glass, T

Grawe, C

Hoesli, I

Mulcahy, F

Rudin, C

Scheibner, K

Thorne, C

UCL Discovery

Oral Abstract  O322Pregnant women with HIV on ART in Europe: how many achievethe aim of undetectable viral load at term and are able to delivervaginally?Aebi-Popp, K1; Mulcahy, F1; Glass, T2; Rudin, C3; Martinez de Tejada, B4; Bertisch, B5; Grawe, C6; Scheibner, K7;Hoesli, I8 and Thorne, C91St James’s Hospital, GUIDE Clinic, Dublin, Ireland. 2University Hospital, Institute of Epidemiology, Basel, Switzerland. 3University Children’s Hospital, Basel,Switzerland. 4University Hospital, Department of Obstetrics and Gynaecology, Geneva, Switzerland. 5Cantonal Hospital, Department of Infectious Diseases, St Gallen,Switzerland. 6University Hospital, Department of Obstetrics and Gynaecology, Zu¨rich, Switzerland. 7University Hospital, Department of Obstetrics and Gynaecology,Bern, Switzerland. 8University Hospital, Department of Obstetrics and Gynaecology, Basel, Switzerland. 9MRC Centre of Epidemiology for Child Health, UCL Instituteof Child Health, London, UK.Purpose of the studyMother-to-child transmission rates in Europe are below 1% in HIV-infected women on successful combined antiretroviral therapy(cART) irrespective of mode of delivery. Consequently, most national guidelines updated between 2001 and 2009 recommendedvaginal deliveries for women with undetectable or very low viral load (VL). The aim of this study was to explore the impact ofthese new guidelines on the rates of vaginal deliveries following complete viral suppression on cART.MethodsA pooled analysis of data on HIV-1-positive women enrolled in the Swiss Mother & Child HIV Cohort Study and the EuropeanCollaborative Study with a live birth between 2000 and 2010 was carried out. Deliveries were classified as occurring pre- or post-publication of national guidelines recommending vaginal delivery in women with low/ undetectable VL for each country.Summary of resultsOverall, 2527 mothers, 2848 deliveries and 2903 births were included from 10 countries. The women were mostly Caucasian(44%) or black (47%) and had a median age of 31 at the time of delivery. They were diagnosed with HIV a median of 3.3 yearsbefore pregnancy and 84% were CDC stage A with a median CD4 cell count of 450 cells/mm3. 17% reported a history ofinjecting-drug use (IDU) and 3% current IDU. 29% of women conceived on cART, 63% started in pregnancy and 8% received noantenatal ART. The most common regimen used was PI based cART (50%). Of the deliveries, elective caesarean section (CS) wascarried out in 58%, emergency CS in 17% and vaginal delivery in 23%. Of 1869 women with a VL measure within the lasttrimester of pregnancy, only 65% had undetectable HIV-RNA. Overall, 21% of all deliveries occurring before the guideline changewere vaginal, increasing to 48% subsequently. The proportion of women with undetectable VL having a CS decreased from 29%before to 13% after the guidelines update.ConclusionsNearly half of all deliveries subsequent to European guideline changes were vaginal. Nevertheless, there are missedopportunities to achieve fully suppressed viral load at time of delivery and to deliver vaginally in HIV infected women. Furtherevaluation of treatment regimens, adherence data and barriers to treatment is planned within these cohorts.Published 11 November 2012Copyright: – 2012 Aebi-Popp K et al; licensee International AIDS Society. This is an open access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided theoriginal work is properly cited.Abstracts of the Eleventh International Congress on Drug Therapy in HIV InfectionAebi-Popp K et al. Journal of the International AIDS Society 2012, 15(Suppl 4):18141http://www.jiasociety.org/index.php/jias/article/view/18141 | http://dx.doi.org/10.7448/IAS.15.6.181411

Pregnant women with HIV on ART in Europe: how many achieve the aim of undetectable viral load at term and are able to deliver vaginally?

http://discovery.ucl.ac.uk/1404690/1/Aebi-Popp_abstract_IAS_2012.pdf

Pregnant women with HIV on ART in Europe: how many achieve the aim of undetectable viral load at term and are able to deliver vaginally?

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