Clinical and Epidemiologic Characteristics of a Cohort of HIV-Infected Mother-Infant Pairs During 21 Years.

BACKGROUND: HIV infection continues to be a worldwide public health problem. After the introduction of effective preventive measures, perinatal transmission dramatically decreased. Our aim was to assess the sociodemographic changes in pregnant women living with HIV infection and trends in perinatal transmission rates over time. SETTING: The Madrid cohort of HIV-infected mother-infant pairs is a multicenter, prospective, observational, and cohort study that collects information on HIV-infected pregnant women and their children. METHODS: Information on clinical-epidemiological characteristics of HIV-infected pregnant women until delivery and their children from 9 public hospitals was included. Data were collected from a standardized questionnaire from medical records. The results were classified in 3 periods: period 1 (P1) 2000-2006, period 2 (P2) 2007-2013, and period 3 (P3) 2014-2020. RESULTS: A total of 1521 women living with HIV and 1548 newborns were included. In P1, most mothers (75.8%) were Spanish, whereas in P2 and P3 there was a predominance of foreign origin [62.8% and 70.5% respectively ( P < 0.01)]. The percentage of women with antiretroviral treatment before pregnancy increased significantly in P3 ( P < 0.01). The proportion of Caesarean sections decreased over time ( P < 0.01): 66.2% (n = 472) in P1, 54.9% (n = 245) in P2, and 46.7% (n = 141) in P3. The percentage of preterm and low birth weight newborns showed a statistically significant decrease. Even though there were no statistically significant differences ( P = 0.154), a decrease in cases of perinatal infection was observed (1.6% in P1, 1.3% in P2 and 0.3% in P3). CONCLUSIONS: The epidemiologic characteristics of pregnant women with HIV infection have changed over time in our setting, with an increase of non-Caucasian, heterosexual, and perinatally infected mothers. Although there are still perinatal infections, especially in vulnerable populations such as immigrant women, transmission rate has markedly decreased in recent years and is still of major concern. Prevention measures should be reinforced in the most socially disadvantaged groups.

Safety and Experience With Combined Antiretroviral Prophylaxis in Newborn at High-risk of Perinatal HIV Infection, in a Cohort of Mother Living With HIV-infant Pairs.

BACKGROUND: Perinatal transmission of HIV has dramatically decreased in high-income countries in the last few years with current rates below 1%, but it still occurs in high-risk situations, mainly pregnant women with late diagnosis of infection, poor antiretroviral adherence and a high viral load (VL). In these high-risk situations, many providers recommend combined neonatal prophylaxis (CNP). Our aim was to evaluate the safety and toxicity of CNP in infants deemed at high-risk of HIV infection among mother-infant pairs in the Madrid Cohort. MATERIALS AND METHODS: Prospective, multicenter, observational cohort study between years 2000 and 2019. The subgroup of newborns on CNP and their mothers were retrospectively selected (cohort A) and compared with those who received monotherapy with zidovudine (cohort B). Infants with monotherapy were classified according to treatment regimes in long (6 weeks) and short (4 weeks) course. RESULTS: We identified 227 newborns (33.3% preterm and 7 sets of twins) with CNP. A maternal diagnosis of HIV-1 infection was established during the current pregnancy in 72 cases (36.4%) and intrapartum or postpartum in 31 cases (15.7%). Most infants received triple combination antiretroviral therapy (65.6%; n = 149). The perinatal transmission rate in cohort A was 3.5% (95% confidence interval: 1.13%-5.92%). Infants from cohort A developed anemia (26.1% vs. 19.4%, P = 0.14) and neutropenia more frequently at 50-120 days (21.4% vs. 10.9%, P < 0.01), without significant differences in grade 3 and 4 anemia or neutropenia between the two cohorts. There were no differences in increased alanine aminotransferase. Neutropenia was more common in the long zidovudine regimes. CONCLUSIONS: Our findings provide further evidence of the safety of CNP in infants with high-risk of HIV-1 perinatal transmission.

Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort. / Efectividad y seguridad de inhibidores de integrasa en la gestante con infección VIH en la Cohorte de embarazadas de la Comunidad de Madrid.

INTRODUCTION: The risk of HIV-1 mother-to-child transmission (MTCT) is associated mainly with gestational age at which antiretroviral therapy begins and the HIV-1 RNA plasma viral load at delivery. Regimens with integrase inhibitors (INI) are increasing in high-risk pregnant women. The objective was to review the experience with INI in a Madrid Cohort of mother-infant pairs. PATIENTS AND METHODS: Retrospective, multicentric, observational study, of HIV-infected pregnant women exposed to INI. Patients of 9 hospitals were included (2000-2017). RESULTS: Sixty-seven pregnant women exposed to INI (cohort: 1,423) and 68 children (17.6% premature babies, 34.3% with combined postexposure prophylaxis). There were no cases of MTCT. Of 24 women with no previous antiretroviral therapy, 20 were diagnosed in current pregnancy. Of 43 women with antiretroviral therapy before pregnancy, 65% received INI before conception. Raltegravir was the most used (80.5%). There was a statistically significant increase (p = 0,02) of mothers with undetectable viral load at delivery. INI were well tolerated. In 11.7% of exposed children minor congenital anomalies were detected. CONCLUSIONS: INI seem safe and effective in the prevention of MTCT. Our findings support their use as intensification regimens in pregnant women with high risk of MTCT.

Efectividad y seguridad de inhibidores de integrasa en la gestante con infección VIH en la Cohorte de embarazadas de la Comunidad de Madrid / Effectiveness and safety of integrase inhibitors in HIV-infected pregnant women followed up in the Madrid Cohort

INTRODUCCIÓN: El riesgo de transmisión vertical (TV) del VIH depende fundamentalmente de la edad gestacional de inicio del tratamiento antirretroviral y la carga viral materna al parto. Son crecientes las pautas con inhibidores de integrasa (INI) en embarazadas con situaciones de riesgo. Nuestro objetivo fue revisar la experiencia con INI en la Cohorte de Madrid de madres-niños. PACIENTES Y MÉTODOS: Estudio retrospectivo, multicéntrico, observacional, de gestantes con infección por VIH-1 expuestas a INI de 9 hospitales públicos durante 2000-2017. RESULTADOS: Hubo 67 gestantes (cohorte: 1.423) y 68 neonatos (el 17,6% prematuros, el 34,3% con profilaxis combinada). No hubo casos de TV. Veinte mujeres se diagnosticaron en la gestación actual. De 43 con tratamiento antirretroviral previo a gestación, el 65% recibía INI preconcepcional. El más empleado fue raltegravir (80,5%). Aumentó significativamente (p = 0,02) la proporción de madres con carga viral indetectable al parto. La tolerancia a INI fue adecuada. Hubo anomalías congénitas menores en el 11,7% de los niños. CONCLUSIONES: Los INI parecen seguros y eficaces como prevención de TV. Nuestros hallazgos refuerzan su utilidad como intensificación en gestantes que llegan al tercer trimestre con pauta no supresora

INTRODUCTION: The risk of HIV-1 mother-to-child transmission (MTCT) is associated mainly with gestational age at which antiretroviral therapy begins and the HIV-1 RNA plasma viral load at delivery. Regimens with integrase inhibitors (INI) are increasing in high-risk pregnant women. The objective was to review the experience with INI in a Madrid Cohort of mother-infant pairs. PATIENTS AND METHODS: Retrospective, multicentric, observational study, of HIV-infected pregnant women exposed to INI. Patients of 9 hospitals were included (2000-2017). RESULTS: Sixty-seven pregnant women exposed to INI (cohort: 1,423) and 68 children (17.6% premature babies, 34.3% with combined postexposure prophylaxis). There were no cases of MTCT. Of 24 women with no previous antiretroviral therapy, 20 were diagnosed in current pregnancy. Of 43 women with antiretroviral therapy before pregnancy, 65% received INI before conception. Raltegravir was the most used (80.5%). There was a statistically significant increase (p = 0,02) of mothers with undetectable viral load at delivery. INI were well tolerated. In 11.7% of exposed children minor congenital anomalies were detected. CONCLUSIONS: INI seem safe and effective in the prevention of MTCT. Our findings support their use as intensification regimens in pregnant women with high risk of MTCT

Lipodistrofia en pacientes con VIH/SIDA: Estudio descriptivo, prospectivo, transversal sobre la incidencia de lipodistrofia en pacientes pediátricos con VIH/SIDA que reciben terapia antirretroviral en clínica de atención integral de VIH/SIDA, Hospital Regional de Occidente San Juan de Dios durante mayo a junio de 2011 / ILipodistrofia in patients with HIV / AIDS: a descriptive, prospective, cross-sectional study on the prevalence of lipodystrophy in pediatric patients with HIV / AIDS receiving antiretroviral therapy clinic comprehensive HIV / AIDS, Western Regional Hospital San Juan de Dios in may june 2011

El uso de la terapia antirretroviral ha mejorado la calidad de vida de los niños. El inicio de estos fármacos ha sido muy positivo en la lucha contra la pandemia de VIH/sida, hasta el momento es la única con la que se cuenta para el control de la infección pero la introducción en el organismo de estos fármacos con actividad enzimática supone en muchos casos una reacción adversa al propio cuerpo. Así se describen numerosos efectos secundarios asociados al uso de estos medicamentos...