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The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

  1. K Boer1,*,
  2. JF Nellen2,
  3. D Patel3,
  4. S Timmermans4,
  5. C Tempelman4,
  6. M Wibaut1,
  7. MA Sluman1,
  8. ME Van Der Ende4,
  9. MH Godfried2

Article first published online: 5 DEC 2006

DOI: 10.1111/j.1471-0528.2006.01183.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 114, Issue 2, pages 148–155, February 2007

Additional Information

How to Cite

Boer, K., Nellen, J., Patel, D., Timmermans, S., Tempelman, C., Wibaut, M., Sluman, M., Van Der Ende, M. and Godfried, M. (2007), The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 148–155. doi: 10.1111/j.1471-0528.2006.01183.x

Author Information

  1. 1

    Department of Obstetrics

  2. 2

    Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands

  3. 3

    Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, University College London, London, UK

  4. 4

    Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands

*Dr K Boer, AMC H4-218, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands. Email k.boer@amc.uva.nl

Publication History

  1. Issue published online: 9 JAN 2007
  2. Article first published online: 5 DEC 2006
  3. Accepted 15 October 2006. Published OnlineEarly 4 December 2006.

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Keywords:

  • Antiretroviral therapy;
  • disease transmission;
  • highly active;
  • HIV seropositivity;
  • infant;
  • newborn;
  • pregnancy;
  • prevention and control;
  • vertical

Objective  To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART).

Design  Cohort of 143 pregnant HIV-1-infected women including a matched case–control study in a 2:1 ratio of controls to cases (n = 98).

Setting  Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands.

Population  Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women.

Main outcome measures  MTCT, preterm delivery, low birthweight, pre-eclampsia.

Results  MTCT was 0% (95% CI 0–2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11–27) in women infected with HIV-1 and 9% (95% CI 5–13) in controls (P = 0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls.

Conclusions  We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.

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