ObjectiveThe aim of the study was to assess the risk of adverse pregnancy outcomes after antenatal antiretroviral therapy in a well-defined prospective cohort of nontransmitting HIV-infected women. MethodsProspective monitoring of 183 mother-child pairs from 13 centres in Germany and Austria, delivering between 1995 and 2001, was carried out. Following German-Austrian guidelines recommending an elective Caesarean section (CS) at 36 weeks, prematurity was defined as o36 weeks' gestation for these analyses. ResultsOf 183 mother-child pairs, 42% were exposed to antenatal monotherapy and 17% to dual therapy. Of the 75 women exposed to highly active antiretroviral therapy (HAART), 21 (28%) received protease inhibitor (PI)-based HAART and the remaining 54 received nonnucleoside reverse transcriptase inhibitor-based HAART. In multivariable analysis (176 pregnancies), PI-based HAART exposure during pregnancy was associated with an increased risk of premature delivery [adjusted odds ratio 3.40; 95% confidence interval (CI) 1.13-10.2; P 5 0.029, compared with monotherapy]. Congenital abnormalities affected 3.3% infants. Perinatally, 18.9% of children (34 of 179) had respiratory problems requiring interventions, which were associated with prematurity but not with type of treatment exposure. From adjusted regression analysis, the mean birth weight z-score for children exposed to HAART with PI ( 1 0.46; 95% CI 0.01-0.92; P 5 0.047) or dual therapy ( 1 0.43; 95% CI 0.03-0.82; P 5 0.034) was slightly but significantly higher than that for those exposed to monotherapy; head circumference was appropriate for gestational age and there were no significant differences between treatment groups. ConclusionsUse of antenatal PI-based HAART initiated before or during pregnancy was associated with a significantly increased risk of premature delivery at o36 weeks' gestation. The overall crude prematurity rate was 34% (63 of 183; 95% CI 28-42).Keywords: congenital abnormalities, HAART, HIV, pregnancy, prematurity There is a consistent body of evidence from European studies showing an increased risk of premature delivery with antenatal combination antiretroviral therapy (ART) and highly active antiretroviral therapy (HAART), especially with regimens containing a protease inhibitor (PI) [5,[7][8][9][10]. Although most studies based in the USA have not found such an association [11][12][13], a more recent, singlecentre study from Florida reported results consistent with those from Europe [14]. Concerns have also been raised over the possible teratogenic effects related to ART exposure in early pregnancy when organogenesis is occurring, although recent reports indicating a low prevalence of congenital malformations in infants with ART exposure have been reassuring [15,16].We assessed the risk of adverse pregnancy outcomes, namely neonatal and perinatal morbidity, prematurity and birth defects, associated with the use of antenatal ART in a well-defined bi-national cohort of nontransmitting HIVinfected pregnant women and their children. MethodsP...

Antiretroviral transmission prophylaxis is associated with significant anemia and neutropenia in HIV-uninfected infants during the first 3 months of life. Anemia was more profound in HAART-exposed infants.

Our findings indicate distinct differences in the epidemics in pregnant women across Europe. The evolution of the MTCT epidemic in Ukraine does not appear to be following the same pattern as that in Western Europe in the 1980s and 1990s. Although uptake of preventive MTCT prophylaxis has been rapid in both Western Europe and Ukraine, substantial challenges remain in the more resource-constrained setting in Eastern Europe.

Fragestellung: Ziel der Untersuchung war, durch die Analyse der Schwangerschaftsverläufe HIV-infizierter Frauen und deren kindlichem Outcome an 10 deutschen gynäkologisch-geburtshilflichen HIV-Schwerpunktzentren die aufgetretenen Komplikationen und die resultierende Rate der vertikalen Transmission zu eruieren. Patientinnen und Methodik: Es wurden insgesamt 599 Schwangerschaften HIV-infizierter Mütter aus den Jahren 1999 -2003 aus 10 Einrichtungen der Schwerpunktversorgung in die Untersuchung aufgenommen. Folgende Parameter wurden hierbei erfasst: Infektionsmodus und -zeitpunkt der Mutter, Entbindungsmodus und Gestationsalter bei Geburt, CD4-Zellzahl bei Feststellung der Schwangerschaft sowie peripartal, Viruslast im Verlauf, ART (antiretrovirale Therapie) zuvor, ART in der Schwangerschaft, Schwangerschaftskomplikationen sowie kindlicher Infektionsstatus und allgemeiner kindlicher Gesundheitszustand. Ergebnisse: In 55 % der Fälle wurden eine oder mehrere Schwangerschaftskomplikationen dokumentiert, am häufigsten vorzeitige Wehentätigkeit (21,4%) und vorzeitiger Blasensprung (4,7 %). 595/599 Schwangerschaften endeten mit einer Lebendgeburt; davon wurden 98,3 % per Sectio caesarea entbunden. 20,3% der Schwangeren erlitten eine Frühgeburt. Fast 50 % der Frauen benötigten eine hochaktive antiretrovirale Mehrfachtherapie (HAART). Die kindliche Infektionsrate betrug 1,68 % (10 Kinder). Schlussfolgerung: Die Ergebnisse zeigen, dass eine in Abstract Objective: The study was performed to evaluate the course of pregnancies of HIV-infected women and their fetal outcome at 10 German reference gynecology/obstetrics departments to provide an overview of occurring complications and the rate of mother-to-child transmission (MTCT). Material and Methods: 599 pregnancies of HIV-infected mothers in the years 1999 -2003 at 10 German reference gynecology/obstetrics departments were recruited for evaluation. Data collected were: mode and time of infection and time of first diagnosis, mode and week of delivery, CD4 count and viral load at diagnosis of pregnancy and at delivery, antiretroviral therapy before and during pregnancy, pregnancy complications, fetal infection and general health status. Results: 595/599 pregnancies resulted in a live birth delivered in 98.3 % by cesarean section. In 55 % of the pregnancies one or more complications were documented. The most common were premature contractions (21.4 %) and premature rupture of the membranes (4.7 %). 20.3 % of the pregnant women delivered prematurely. Almost 50% of the women needed a highly active antiretroviral combination therapy (HAART). The vertical transmission rate was found to be 1.68 % (10 children). Conclusions:The study shows that the rate of mother-to-child transmission (MTCT) finally resulting after therapy according to the German-Austrian recommendations for HIV therapy in pregnancy is very low (under 2 %). Nevertheless, in order to achieve Originalarbeit 1058

ZusammenfassungFragestellung: Durch die Einführung von Buprenorphin (BUP, Subutex ) in die Substitutionstherapie von opiatabhängigen Schwangeren fand eine Bereicherung der Therapiemöglichkeiten statt. Die bisher veröffentlichten Ergebnisse zur Buprenorphinsubstitution in der Schwangerschaft beinhalteten keine Auswertung der Umstellungsphase und gaben nur unzureichende Hinweise zum Vorgehen bei der Buprenorphinumstellung von mit Heroin oder Methadon substituierten Schwangeren. Material und Methodik: Seit der Einführung von BUP in das Therapiespektrum der Infektionsambulanz der Klinik für Geburtsmedizin der CharitØ im Juni 2000 wurden von insgesamt 114 opiatabhängigen Schwangeren 33 (29%) in der Schwangerschaft mit BUP substituiert. 27 dieser Patientinnen wurden durch die Ambulanz auf BUP umgestellt, 6 Patientinnen waren bereits mit BUP substituiert. Von den 114 Patientinnen wurde eine Vergleichsgruppe mit 56 opiatabhängigen Patientinnen (49,1 %) ausgewählt, bei denen entsprechend unserer Einschlusskriterien eine Buprenorphinumstellung in der Schwangerschaft möglich gewesen wäre, eine Umstellung jedoch nicht durchgeführt wurde. Die vorliegende Analyse vergleicht die geburtsmedizinischen und neonatalen Ergebnisse von mit BUP substituierten Schwangeren mit den Ergebnissen bei Methadon-(L-Polamidon -) Substitution. Ergebnisse: In der statistischen Analyse zeigen die beiden Vergleichskollektive keine signifikanten demografischen oder anamnestischen Unterschiede, auch der Anteil von Schwangeren Abstract Purpose: With the introduction of buprenorphine (BUP, Subutex ) for the treatment of pregnant opiate addicts the therapeutical spectrum for these patients was enhanced. Current publications showed advantages of BUP compared to methadone but did not explain how the switching of substances could be accomplished. We have evaluated our data to give recommendations on the use of buprenorphine in pregnancy. Material and Methods: Since the introduction of BUP in our therapeutic concept in June 2002 we have treated a total of 114 pregnant opiate addicts. 33 (29 %) of the patients were substituted with BUP. Out of the group of patients not treated with BUP we selected a control-group of 56 patients (49.1%) that met our criteria for BUP treatment but did not switch to BUP for various reasons. The analysis presented here compares obstetrical and neonatological data between the BUP and methadone (L-Polamidon ) group.Results: The statistical analysis shows no significant difference with respect to demographical and obstetrical parameters between the two groups. The number of women with additional consumption of illegal substances is comparable as well. The most important difference is a significantly shorter duration of neonatal care for the group of BUP-exposed neonates compared to the methadone group. Conclusion: Treatment of pregnant opiate addicts with the help of a substitution therapy with buprenorphine is easily accomOriginalarbeit