Trends in HIV Prevalence Among Pregnant Women in Italy, 1994 to 2002

Girardi, Enrico; Vanacore, Paola; Costa, Francesco; Solmone, Mariacarmela; Angeletti, Claudio; Capobianchi, Maria Rosaria; Ippolito, Giuseppe

doi:10.1097/01.qai.0000209900.05126.25

Cited by 17 publications

(11 citation statements)

References 13 publications

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“…16 Despite more than 1000 cases, the study sample size did not provide enough power to evaluate associations with specific defects, and CIs for the prevalence of birth defects for some drugs were still relatively wide. Nonetheless, prevalence data are consistent with the main reference sources, and no drugs showed a birth defect rate above 5% for first-trimester exposure.…”

Section: Strength and Weaknessesmentioning

confidence: 99%

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Floridia

Mastroiacovo²,

Tamburrini

et al. 2013

BJOG

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Objective We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection.Design Observational study.Setting University and hospital clinics.Population Pregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy.Methods The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses.Main outcome measures Birth defects, defined according to the Antiretroviral Pregnancy Registry criteria.Results A total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9-4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9-4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and firsttrimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51-1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51-1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56-2.55; protease inhibitors, OR 0.92, 95% CI 0.43-1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%).Conclusions This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.

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Section: Strength and Weaknessesmentioning

confidence: 99%

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Floridia

Mastroiacovo²,

Tamburrini

et al. 2013

BJOG

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“…Our study examined different aspects of treatment and care during pregnancy and provided information on ARV treatment and pregnancy outcomes in a large cohort of HIV‐infected women of different provenance followed in a European country. Recent data on HIV seroprevalence at delivery in Italy indicate an estimated seroprevalence of 0.66 per 1000, corresponding to an estimate of 346 liveborns from HIV‐positive mothers in 2002 11 . Our study and the data provided here, based on about 1000 pregnancies reported in less than 5 years, represent the vast majority of the pregnancies occurring in HIV‐positive women in Italy, with a nationwide distribution of participating centres.…”

Section: Discussionmentioning

confidence: 57%

Pregnancy outcomes and antiretroviral treatment in a national cohort of pregnant women with HIV: overall rates and differences according to nationality

Floridia¹,

Tamburrini²,

Bucceri³

et al. 2007

BJOG

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We used data from the main surveillance study of HIV and pregnancy in Italy to evaluate possible differences in pregnancy care and outcomes according to nationality. Among 960 women followed in 2001-06, 33.5% were of foreign nationality, mostly from African countries. Foreign women had lower rates of preconception counselling and planning of pregnancy. They had more frequently HIV diagnosed during pregnancy, with a later start of antiretroviral treatment and lower treatment rates at all trimesters but not when the entire pregnancy, including delivery, was considered. No differences were observed between the two groups in ultrasonography assessments, hospitalisations, AIDS events, intrauterine or neonatal deaths, and mode and complications of delivery. Foreign women had a slightly lower occurrence of preterm delivery and infants with low birthweight. The results indicate good standards of care and low rates of adverse outcomes in pregnant women with HIV in Italy, irrespective of nationality. Specific interventions, however, are needed to increase the rates of counselling and HIV testing before pregnancy in foreign women.

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“…This is an ongoing observational study established in Italy in 2001, which covers, based on available prevalence data [6], roughly 30–40% of live births from women with HIV in Italy. Site participation is voluntary, and at present is based on more than 30 clinicians reporting from Obstetrics, Infectious Diseases, and Paediatrics departments across the country.…”

Section: Methodsmentioning

confidence: 99%

Evolving treatment implementation among HIV–infected pregnant women and their partners: results from a national surveillance study in Italy, 2001–2015

Floridia¹,

Frisina²,

Ravizza³

et al. 2017

Journal of Global Health

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BackgroundThe current global and national indications for antiretroviral treatment (ART, usually triple combination therapy) in adolescent and adults, including pregnant women, recommend early ART before immunologic decline, pre–exposure chemoprophylaxis (PrEP), and treatment of HIV–negative partners in serodiscordant couples. There is limited information on the implementation of these recommendations among pregnant women with HIV and their partners.MethodsThe present analysis was performed in 2016, using data from clinical records of pregnant women with HIV, followed between 2001 and 2015 at hospital or university clinics within a large, nationally representative Italian cohort study. The study period was divided in three intervals of five years each (2001–2005, 2006–2010, 2011–2015), and the analysis evaluated temporal trends in rates of HIV diagnosis in pregnancy, maternal antiretroviral treatment at conception, prevalence of HIV infection among partners of pregnant women with HIV, and proportion of seronegative and seropositive male partners receiving antiretroviral treatment.ResultsThe analysis included 2755 pregnancies in women with HIV. During the three time intervals considered the rate of HIV diagnosis in pregnancy (overall 23.3%), and the distribution of HIV status among male partners (overall 48.7% HIV–negative, 28.6% HIV–positive and 22.8% unknown) remained substantially unchanged. Significant increases were observed in the proportion of women with HIV diagnosed before pregnancy who were on antiretroviral treatment at conception (from 62.0% in 2001–2005 to 81.3% in 2011–2015, P < 0.001), and in the proportion of HIV–positive partners on antiretroviral treatment (from 73.3% in 2001–2005 to 95.8% in 2011–2015, P = 0.002). Antiretroviral treatment was administered in 99.1% of the pregnancies that did not end early because of miscarriage, termination, or intrauterine death, and in 75.3% of those not ending in a live birth. No implementation of antiretroviral treatment was introduced among male HIV–negative partners.ConclusionsThe results suggest good implementation of antiretroviral treatment among HIV–positive women and their HIV–positive partners, but no implementation, even in recent years, of Pre–Exposure Prophylaxis (PrEP) among uninfected male partners. Further studies should assess the determinants of this occurrence and clarify the attitudes and the potential barriers to PrEP use.

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Trends in HIV Prevalence Among Pregnant Women in Italy, 1994 to 2002

Abstract: The number of children born to an HIV-positive mother calls for continued efforts to prevent vertical transmission of the infection.

Cited by 17 publications

References 13 publications

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001–2011

Pregnancy outcomes and antiretroviral treatment in a national cohort of pregnant women with HIV: overall rates and differences according to nationality

Evolving treatment implementation among HIV–infected pregnant women and their partners: results from a national surveillance study in Italy, 2001–2015

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