XVIII International AIDS Conference

Abstract

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Neonatal outcomes after perinatal exposure to HIV-1 in Argentina

A. Urueña, D.M. Cecchini, P. Trinidad, F. Vesperoni, D. Mecikovsky, R. Bologna

Helios Salud, Buenos Aires, Argentina

Background: Argentinian data regarding perinatal transmission, preterm birth (PB), congenital defects, neonatal complications (NC) and mortality among infants in utero exposed to HIV-1 are limited. Those outcomes are the aim of this study.
Methods: Retrospective analysis of medical charts of mother-child binomium (MCB) assisted at Helios Salud, Buenos Aires, Argentina (1997-2006). Variables potentially associated with PB (< 37 weeks) and NC were analyzed by logistic regression. We evaluated maternal CD4-cell count, CDC category, antiretroviral therapy (ARV), early ARV exposure during pregnancy and obstetric complications for PB; and maternal ARV, obstetric complications, mode of delivery, PB and birth weight < 2500 g for NC. Software: Statistix 7.0.
Results: 204 MCB were analyzed: 18 lost of follow-up before delivery. Of 181 live births, 138 completed diagnosis of HIV-1 infection. Ninety-eight percent received ARV during pregnancy (2 INTR+Nevirapine: 55%; 2 INTR+PI: 32%). Nelfinavir was the most frequently PI used (47/65; 72%). Intrapartum zidovudine: 98% (174/178), and 99% of infants received zidovudine prophylaxis. No woman breastfed. Mode of delivery (n= 183): vaginal: 16%; scheduled cesarean section: 68%; emergency cesarean section: 16%. Obstetric complications: 26%. PB: 16%; 95% CI: 10-22% (26% in MCB under PI vs. 11% without PI, p=0.03). Birth weight < 2500 g: 10% (17/164 available birth weights) which was associated with PB (p< 0.001). Of the newborns, 1.6% had congenital defects and 9% NC. Overall neonatal mortality: 2.2%; perinatal transmission: 0.7% (1/138). PI use and obstetric complications were associated to PB (OR: 3.21; 95% CI: 1.33-7.75 and OR: 3.51 95% CI: 1.42-8.64, respectively). Obstetric complications were associated with NC (OR: 3.63; 95% CI: 1.27-10.34), no evidence was found for any other association.
Conclusions: In this study, perinatal transmission of HIV-1 infection was low. We found a high rate of PB, compared to 8% of the general population. An association between PI-use and PB was shown.


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