Human Immunodeficiency Virus Disease Control in a Cohort of Pregnant Women Delivering in Birmingham, Alabama [304]. (May 2015)

• Record Type: Journal Article
• Authors: Wallace, Suzanne; Khan, Michelle J.; Dionne-Odom, Jodie; Tita, Alan T. N.; Parks, Mickey; Crain, Marilyn
• Is Part Of: Obstetrics and gynecology. Volume 125(2015)Supplement 1
• Publication Date: 2015-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000463556.27790.2a
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Increased success in preventing perinatal human immunodeficiency virus (HIV) transmission has led to growing interest in assessing optimization of pregnancy care. We describe the virologic control of HIV-positive pregnant women who delivered at the University of Alabama at Birmingham between 2009 and 2013. METHODS: Human immunodeficiency virus-positive women who delivered at the University of Alabama at Birmingham between January 1, 2009, and December 31, 2013, were identified by the University of Alabama at Birmingham's Obstetrics Automated Record; pregnancy data from the University of Alabama at Birmingham's electronic health records were entered into Microsoft Excel and descriptive statistics were performed. RESULTS: Ninety-two HIV-positive women delivered at the University of Alabama at Birmingham during the study period, for a total of 106 pregnancies. Five pregnancies (4.7%) received inadequate prenatal care (less than three visits), of which two had detectable viral load at delivery. In 45 (42.5%) pregnancies, viral load was greater than 40 copies/mL in the first trimester (median 1, 950 copies/mL, range 56–119, 000 copies/mL); 31 (29.2%) had detectable virus at delivery with seven (6.6%) exceeding 1, 000 copies/mL, the threshold at which cesarean delivery before rupture of membranes is recommended to prevent vertical HIV transmission. Nine of 51 (17.6%) women who underwent cesarean delivery received zidovudine infusions for less than 3 hours, and four (7.8%) received none. Five of these 13 women had detectable viral load at delivery, and one woman had a viral load of greater than 1, 000 copies/mL. CONCLUSION: A significant percentage (29.2%) of women had detectable viral loads at delivery despite treatment with an adequate antiretroviral regimen and no evidence of viral resistance. These results highlight adherence issues that require further exploration. Despite adequate prenatal care, a large percentage of HIV-positive Alabama women had suboptimal HIV control during pregnancy.