The second generation of HIV-1 vertically exposed infants: a case series from the Italian Register for paediatric HIV infection
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
BMC Infectious Diseases 2014, 14:277 doi:10.1186/1471-2334-14-277Published: 20 May 2014
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.
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.
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.
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.