Pregnancy in HIV vertically-infected adolescents: a new generation of HIV-exposed infants
M.L. Cruz1, C. Cardoso2, E. João2, I. Gomes3, T. Abreu4, R.H. Oliveira4, E. Machado4, I.R. Dias5, N. Rubini6, R. Succi7
1Hospital dos Servidores do Estado, Infectious Diseases, Rio de Janeiro, Brazil, 2Hospital dos Servidores do Estado, Rio de Janeiro, Brazil, 3Universidade Federal Fluminense, Niterói, Brazil, 4Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil, 5Hospital de Jacarepagua/Ministério da Saúde, Rio de Janeiro, Brazil, 6Hospital Universitario Gafree e Guinle, Rio de Janeiro, Brazil, 7Universidade Federal de São Paulo, São Paulo, Brazil
Background: As vertically infected individuals reaches childbearing age a new generation of HIV exposed infants demands attention.
Methods: Chart review of pregnancies in vertically infected girls for data before and during pregnancy, delivery and infant outcomes.
Results: Fifteen pregnancies in eleven HIV vertically infected adolescents from 2002 to 2009. Median age of HIV diagnosis was 10.1 years [IQR: 6.4 - 12.8]. Six grandmothers are still alive, one had received ARV during gestation. Girls started sexual life at median age of 15 years [IQR: 14 - 15]; median age at the time of first pregnancy was 16.9 years [IQR: 15.7 - 18.0]. At pregnancy diagnosis 8/15 (53.3%) were CDC C; have been followed for median 8.4 years [IQR: 6.2 - 10.6] and had used median 2 ARV regimens [IQR: 1 - 4]. Fourteen (93.3%) received ARV during pregnancy; median CD4 during pregnancy was 394 [IQR: 213 - 494] cells/mm3 and median viral load was 4,800 copies/ml [IQR: 502 - 16,000]; 54% (6/11) had undetectable viral load near delivery. Three girls had HPV infection, 2 had bacterial vaginosis and 1 vaginal candidiasis. All patients delivered by elective c-section. One newborn had severe perinatal anoxia. Median birth weight was 2,650 g [IQR: 2,430 - 3,250], median length was 47.3 cm [IQR: 46.3 - 49] and median gestational age, 38 weeks [IQR: 37 - 39]. All newborn received ZVD for 6 weeks of life and no one was breastfed. Twelve (80%) infants were considered HIV-uninfected, and three are still under investigation.
Conclusions: This group of adolescents under ARV for years has satisfactory reproductive health, and sexual behavior similar to that of HIV-uninfected adolescents. Since this is an experimented ARV population, new drugs may be necessary for adequate viral suppression to avoid MTCT. Follow-up of this third generation of HIV-exposed infants needs to be addressed within HIV adolescent care.
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