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Open Access Research article

The second generation of HIV-1 vertically exposed infants: a case series from the Italian Register for paediatric HIV infection

Carmelina Calitri1, Clara Gabiano1, Luisa Galli2, Elena Chiappini2, Carlo Giaquinto3, Wilma Buffolano4, Orazio Genovese5, Susanna Esposito6, Stefania Bernardi7, Maurizio De Martino2, Pier-Angelo Tovo1* and the Italian Register for HIV Infection in Children

Author Affiliations

1 Department of Paediatrics, University of Turin, Turin, Italy

2 Department of Health Sciences, University of Florence, Florence, Italy

3 Department of Paediatrics, Padua University, Padua, Italy

4 Coordinating Centre for Perinatal Infection of Campania Region, Translational Medical Sciences Department of Federico II University, Naples, Italy

5 Department of Emergency, Catholic University of Rome, Rome, Italy

6 Paediatric Clinic 1, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

7 Department of Immunology and Infectious Diseases, "Bambino Gesù" Children’s Hospital, Rome, Italy

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BMC Infectious Diseases 2014, 14:277  doi:10.1186/1471-2334-14-277

Published: 20 May 2014

Abstract

Background

In the Highly Active Antiretroviral Therapy (HAART) era, the prognosis of children perinatally infected with HIV-1 has significantly improved, so the number of perinatally-infected females entering child-bearing age and experiencing motherhood is increasing.

Methods

A description of the medical history and pregnancy outcomes of women with perinatal acquired HIV-1 infection enrolled in the Italian Register for HIV infection in Children.

Results

Twenty-three women had 29 pregnancies. They had started an antiretroviral therapy at a median of 7.7 years (interquartile range, IQR 2.3 - 11.4), and had experienced a median of 4 therapeutic regimens (IQR 2–6). Twenty women (87%) had taken zidovudine (AZT) before pregnancy, in 14 cases as a starting monotherapy. In 21 pregnancies a protease inhibitor-based regimen was used. At delivery, the median of CD4+ T lymphocytes was 450/μL (IQR 275–522), and no viral load was detectable in 15 cases (reported in 21 pregnancies). Twenty-eight children were delivered through caesarean section (median gestational age: 38 weeks, IQR 36–38, median birth weight: 2550 grams, IQR 2270 – 3000). Intravenous AZT was administered during delivery in 26 cases. All children received oral AZT (median: 42 days, IQR 31 – 42), with no adverse events reported. No child acquired HIV-1 infection.

Conclusions

Despite a long history of maternal infection, multiple antiretroviral regimens and, perhaps, the development of drug-resistant viruses, the risk of mother-to-child transmission does not seem to have increased among the second-generation of HIV-1 exposed infants.

Keywords:
HIV-1; Drug-resistant virus; AZT; Vertical transmission