RESUMEN
BACKGROUND: The unquestionable benefit of antiretroviral therapy in reducing the rate of mother-to-child transmission can be lessened by potential maternal or neonatal toxicity. OBJECTIVE: To analyze obstetric and perinatal complications in a cohort of HIV-infected pregnant women and their relationship with maternal antiretroviral therapy. POPULATION: One hundred and sixty-seven HIV-infected pregnant women who delivered at Hospital Universitario La Paz, Madrid, Spain between January 1997 and December 2003. METHODS: Data on the clinical and epidemiological characteristics of HIV-infected patients, previous and current antiretroviral therapy, gestational diabetes mellitus, length of pregnancy, mode of delivery, and weight of the newborn were collected. Pregnancy outcomes were compared with those of all the pregnant women attended at our hospital. MAIN OUTCOME MEASURES: Gestational diabetes mellitus, premature delivery, and low birth weight. RESULTS: Gestational diabetes mellitus was diagnosed in 8.9% of patients. All the cases of gestational diabetes were in the combined antiretroviral therapy group, and the majority were receiving triple antiretroviral therapy with a protease inhibitor. The risk of developing this pathology was greater among women receiving antiretroviral therapy prior to pregnancy. The premature delivery rate was 29% and the low birth weight rate was 28%. CONCLUSION: Gestational diabetes mellitus is more common in HIV-infected women than in the general population and is related to combined antiretroviral therapy, especially the use of protease inhibitors, which suggests the need for close follow-up during pregnancy in HIV-infected patients. Nevertheless, the adverse perinatal consequences observed were more related to maternal factors than to antiretroviral therapy.
Asunto(s)
Fármacos Anti-VIH/efectos adversos , Diabetes Gestacional/epidemiología , Infecciones por VIH/tratamiento farmacológico , Complicaciones del Trabajo de Parto/epidemiología , Complicaciones Infecciosas del Embarazo/epidemiología , Inhibidores de Proteasas/efectos adversos , Adulto , Fármacos Anti-VIH/uso terapéutico , Estudios de Cohortes , Diabetes Gestacional/inducido químicamente , Femenino , Infecciones por VIH/transmisión , Hepatitis C/complicaciones , Hepatitis C/epidemiología , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones del Trabajo de Parto/prevención & control , Trabajo de Parto Prematuro/epidemiología , Trabajo de Parto Prematuro/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Inhibidores de Proteasas/uso terapéutico , Factores de Riesgo , España/epidemiología , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiologíaRESUMEN
BACKGROUND AND OBJECTIVE: Vertical transmission (VT) is the main route of human immunodeficiency virus (HIV) infection in children. Since the publication of PACTG 076 study in 1994, several preventive methods against the vertical transmission of the HIV have been developed. In this study, we compare the clinical and epidemiological profile of HIV-infected pregnant women and the VT rate in the years 1994 and 2004. PATIENTS AND METHOD: We looked at maternal, obstetric and pediatric variables of HIV-infected women and their children, born in 1994 and 2004, who were followed in Hospital La Paz. RESULTS: We included 40 mother-infant couples in 1994 and 35 couples in 2004. The HIV vertical transmission rate was 35% in 1994 and 0% in 2004. We did not find changes in Hepatitis C virus (HCV) vertical transmission. In 1994, HIV-infected mothers had a more advanced HIV-disease and the major route of HIV-transmission was the intravenous drug use. Vaginal delivery was more frequent and rupture of membranes was longer than in 2004. The main route of maternal HIV infection in 2004 was sexual contact. In this same year, the use of combination antiretroviral therapy, even during pregnancy, was generalized, the elective cesarean section was the most frequent form of delivery, and every newborn received zidovudine. CONCLUSIONS: In the last decade, there have been important epidemiological changes in HIV-infected mothers in our society. The administration of antiretroviral therapy during pregnancy and to the newborn, as well as other obstetric strategies, can prevent HIV vertical transmission. Nevertheless, we did not find any change in the risk of HCV vertical transmission.
Asunto(s)
Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Fármacos Anti-VIH/uso terapéutico , Lactancia Materna/efectos adversos , Cesárea/estadística & datos numéricos , Estudios Transversales , Parto Obstétrico/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Emigración e Inmigración/estadística & datos numéricos , Femenino , Infecciones por VIH/congénito , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Hepatitis C/epidemiología , Hepatitis C/transmisión , Hospitales Universitarios/estadística & datos numéricos , Humanos , Recién Nacido , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Estudios Retrospectivos , Riesgo , Conducta Sexual , España/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Zidovudina/uso terapéuticoRESUMEN
Fundamento y objetivo: Desde la publicación del estudio PACTG 076 en 1994 se han desarrollado medidas profilácticas frente a la transmisión vertical (TV) del virus de la inmunodeficiencia humana (VIH), principal vía de infección infantil por el VIH. Se comparan las características de las embarazadas infectadas por el VIH y las tasas de TV del VIH de 1994 y las de 2004. Pacientes y método: Se estudian las variables maternas, obstétricas y pediátricas de mujeres infectadas por el VIH y sus hijos, nacidos en 1994 y 2004 y seguidos en el Hospital La Paz. Resultados: Se incluye a 40 parejas madre-hijo de 1994 y 35 de 2004. La tasa de TV del VIH fue del 35% en 1994 y del 0% en 2004. No se observaron cambios en la TV del virus de la hepatitis (VHC). En 1994 las madres infectadas por el VIH estaban más sintomáticas y la vía de infección era el uso de drogas intravenosas, el parto vaginal era el más frecuente, y el tiempo de bolsa rota, más prolongado. En 2004 la vía de infección materna por el VIH fue principalmente sexual, se ha generalizado el tratamiento antirretroviral combinado en la mujer seropositiva, en la gestación, la cesárea programada era más frecuente y todos los neonatos recibieron zidovudina. Conclusiones: En una década se han producido importantes cambios epidemiológicos en las gestantes infectadas por el VIH en nuestro medio. La administración de antirretrovirales en el embarazo y al neonato y las medidas obstétricas preventivas pueden evitar la TV del VIH. No obstante, no se ha observado modificación en el riesgo de TV del VHC
Background and objective: Vertical transmission (VT) is the main route of human immunodeficiency virus (HIV) infection in children. Since the publication of PACTG 076 study in 1994, several preventive methods against the vertical transmission of the HIV have been developed. In this study, we compare the clinical and epidemiological profile of HIV-infected pregnant women and the VT rate in the years 1994 and 2004. Patients and method: We looked at maternal, obstetric and pediatric variables of HIV-infected women and their children, born in 1994 and 2004, who were followed in Hospital La Paz. Results: We included 40 mother-infant couples in 1994 and 35 couples in 2004. The HIV vertical transmission rate was 35% in 1994 and 0% in 2004. We did not find changes in Hepatitis C virus (HCV) vertical transmission. In 1994, HIV-infected mothers had a more advanced HIV-disease and the major route of HIV-transmission was the intravenous drug use. Vaginal delivery was more frequent and rupture of membranes was longer than in 2004. The main route of maternal HIV infection in 2004 was sexual contact. In this same year, the use of combination antiretroviral therapy, even during pregnancy, was generalized, the elective cesarean section was the most frequent form of delivery, and every newborn received zidovudine. Conclusions: In the last decade, there have been important epidemiological changes in HIV-infected mothers in our society. The administration of antiretroviral therapy during pregnancy and to the newborn, as well as other obstetric strategies, can prevent HIV vertical transmission. Nevertheless, we did not find any change in the risk of HCV vertical transmission