Pregnancy in HIV-infected teenagers in London

Abstract

There were 67 pregnancies in 58 young women, of whom one was known to have acquired HIV vertically. The overall mother-to-child transmission (MTCT) rate of HIV was 1.5% (one of 66). There were 66 live births. Median ages at HIV diagnosis and conception were 17 and 18 years, respectively. Sixty-three per cent of women were diagnosed with HIV infection through routine antenatal screening. Eighty-two per cent of pregnancies (41 of 50) were unplanned, with 65% of women (26 of 40) using no contraception. Forty-three per cent of the women (20 of 46) had a past history of a sexually transmitted infection (STI). In 63 pregnancies, antiretroviral therapy was started postconception, with prevention of HIV MTCT the only indication in 81% of cases. Fifty-eight per cent of those on highly active antiretroviral therapy (HAART) had an undetectable HIV viral load by delivery. Eighty-seven per cent were uncomplicated pregnancies. Seventy-one per cent delivered by Caesarean section and 21% (14 of 64) had a preterm delivery (o37 weeks). In the 12 months after delivery, 45% of women received contraceptive advice and 25% of women became pregnant again. ConclusionObstetric and virological outcomes were favourable in this group of HIV-infected young women. However, the majority of pregnancies were unplanned with poor documentation of contraception use and advice and low rates of STI screening. A quarter of women conceived again within 12 months of delivery. Effective measures to reduce STIs, unplanned pregnancies and onward HIV transmission in HIV-infected teenagers are needed. Studies exploring pregnancy in HIV-infected adolescents are limited. The largest described 1183 live births in 1090 pregnant adolescents in the United States, the majority of whom had acquired HIV infection sexually [11]. Most pregnancies were unplanned (83%) and occurred in teenagers who had previously been pregnant (67%).A prospective cohort study of 638 vertically infected girls, again in the USA, reported 45 pregnancies, with 17% of girls experiencing a first pregnancy by their 19th birthday [8]. Of the 32 pregnancies resulting in live births, one infant was HIV-infected, 29 were uninfected and two had unknown infection status. Chibber and Khurranna also reported favourable obstetric outcomes and no cases of vertical transmission in a study of 30 pregnant vertically infected adolescents in India [12]. Other case series have described similar findings [13][14][15]. In a small European study, there were nine live births with no mother-to-child transmissions [16]. To date there have been no studies in the UK looking at pregnancy in teenagers living with HIV.In this study we reviewed the pregnancies of 58 HIVinfected teenagers attending for care at 12 London hospitals. We explore the medical and social features of this group and describe their sexual and reproductive health issues, their response to antiretroviral therapy (ART) and pregnancy outcome. MethodsWe conducted a retrospective case note review of HIVinfected pregnant female patients aged between 13 and...

Management and outcomes of pregnancies among women with HIV in Oxford, UK, in 2008–2012

“…At 13%, the present study had a relatively low proportion of women with a viral load of more than 50 copies per mL at delivery compared with other studies [16,17,[19][20][21]. Two studies from London reported the highest rates of detectable viral load at delivery: 38% [16] and 45% [17].…”

“…However, these figures compare favorably with a similar study of teenagers with HIV in London [16], in which most patients had unplanned pregnancies (82%) and booked late (median 17 weeks). Furthermore, national studies suggest that almost half of all pregnancies in the UK are unintended [18].…”

“…Two studies from London reported the highest rates of detectable viral load at delivery: 38% [16] and 45% [17]. Timing of antiretroviral initiation is key to ensure that the viral load is less than 50 copies per mL by delivery, with earlier initiation warranted when the viral load is high in early pregnancy [22].…”

“…In the study of teenagers in London [16], only 6% of patients were taking treatment before conception and nearly all (81%) of those who started treatment in pregnancy were started for PMTCT after a median length of pregnancy of 28 weeks. In the present study, almost half the patients who began treatment during pregnancy did so as a result of low maternal CD4 count, at an earlier median start time of 22 weeks.…”

“…However, up-to-date detailed information on virological and obstetric management of HIV-positive pregnancies in the UK is very limited, especially outside London [16,17]. Therefore, the aim of the present study was to evaluate management and outcomes of pregnancies among women with HIV to identify what improvements can be made.…”