Advertisement

Intrapartum use of zidovudine in a large cohort of pregnant women living with HIV in Italy

Published:August 17, 2022DOI:https://doi.org/10.1016/j.jinf.2022.08.009

      Highlights

      • Peripartum HIV-RNA is the strongest factor influencing vertical transmission of HIV.
      • When HIV-RNA is <50 copies/mL, ART discontinuation is the strongest risk factor.
      • Intrapartum ZDV has no effect on transmission in women with HIV RNA <50 copies/mL.
      • The administration of unnecessary zidovudine may be perceived as a stigma.
      • Study of the U=U concept in mother-child couple could help fight stigma.

      Abstract

      Background

      Intravenous administration of zidovudine (ZDV) during labour is a key step for vertical HIV transmission (VT) prevention, but there is no evidence of benefit when maternal HIV-RNA at delivery is <50 copies/mL. The aim of this study is evaluating the appropriateness of intrapartum ZDV use in Italy.

      Methods

      Observational study including mother-infant pairs with perinatal HIV exposure during 2002-2019, enrolled in the Italian Register for HIV Infection in Children. Univariable and multivariable logistic regression were used to evaluate factors associated with VT.

      Results

      A total of 3,861 infants, born from 3,791 pregnancies were included. The frequency of ZDV use was 79.9%, 92.1%, 93.7% and 92.8% when HIV-RNA was not available, ≥400 copies, between 50 and 399 copies, and <50 copies/mL. Thirty-three out of 3861 (0.85%) infants were subsequently diagnosed with HIV, 25/3861 (0.6%) of them born to mothers receiving intrapartum ZDV, and 31 (93.9%) to mothers with HIV-RNA ≥50 copies/mL or not available. In women with HIV-RNA < 50 copies/mL, ART discontinuation during pregnancy was the strongest risk factor for VT (odds ratio, OR, 23.1, 95%CI 2.4-219.3), while a higher gestational age (OR 0.6, 95%CI 0.4-0.8) and PEP administration to the newborn (aOR 0.004, 95%CI <0.0001-0.4) were protective factors. Intrapartum ZDV administration did not influence the final outcome in this group.

      Conclusions

      In ART era, more transmission events may occur in utero, limiting value of intrapartum ZDV, particularly for women with suppressed HIV-RNA load. More attention to the HIV-RNA testing of mothers before delivery may avoid unnecessary ZDV use.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Connor EM
        • Sperling RS
        • Gelber R
        • et al.
        Reduction of maternal-infant transmission of Human Immunodeficiency Virus Type 1 with Zidovudine treatment.
        N Engl J Med. 1994; 331: 1173-1180https://doi.org/10.1056/NEJM199411033311801
      1. EACS European Aids Clinical Society. Guidelines. Version 11.0. October 2021. https://www.eacsociety.org/media/final2021eacsguidelinesv11.0_oct2021.pdf

      2. Panel on treatment of pregnant women with HIV infection and prevention of perinatal transmission. Recommendations for the use of antiretroviral drugs during pregnancy and interventions to reduce perinatal HIV transmission in the United States.:478. https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/Perinatal_GL.pdf

        • Mandelbrot L
        • Berrébi A
        • Matheron S
        • et al.
        HIV and pregnancy: 2013 guidelines from the French expert working group.
        J Gynecol Obstet Biol Reprod. 2014; 43: 534-548https://doi.org/10.1016/j.jgyn.2014.01.006
      3. British HIV Association (BHIVA). British HIV Association guidelines for the management of HIV in pregnancy and postpartum 2018 (2020 third interim update). Published online 2020. https://www.bhiva.org/file/5f1aab1ab9aba/BHIVA-Pregnancy-guidelines-2020-3rd-interim-update.pdf

      4. Società Italiana di Malattie Infettive (SIMIT). Linee Guida Italiane sull'utilizzo della Terapia Antiretrovirale e la gestione diagnostico-clinic elle persone con infezione da HIV-1. Published online 2017. http://www.salute.gov.it/imgs/C_17_pubblicazioni_2696_allegato.pdf

        • Briand N
        • Warszawski J
        • Mandelbrot L
        • et al.
        Is intrapartum intravenous zidovudine for prevention of mother-to-child HIV-1 transmission still useful in the combination antiretroviral therapy era?.
        Clin Infect Dis. 2013; 57: 903-914https://doi.org/10.1093/cid/cit374
        • Rodger AJ
        • Cambiano V
        • Bruun T
        • et al.
        Sexual activity without condoms and risk of HIV transmission in serodifferent couples when the HIV-positive partner is using suppressive antiretroviral therapy.
        JAMA. 2016; 316: 171https://doi.org/10.1001/jama.2016.5148
        • Lumaca A
        • Chiappini E
        • Gabiano C
        • Angelo Tovo P
        • de Martino M
        • Galli L
        Il Registro Italiano per l'Infezione da HIV in pediatria. L'epidemiologia dell'infezione da HIV nel bambino e nell'adolescente in Italia.
        JHA. 2017; : 3https://doi.org/10.19198/JHA31433
        • Galli L
        • Puliti D
        • Chiappini E
        • et al.
        Is the interruption of antiretroviral treatment during pregnancy an additional major risk factor for mother-to-child transmission of HIV type 1?.
        Clin Infect Dis. 2009; 48: 1310-1317https://doi.org/10.1086/597774
        • Di Biagio A.
        • Taramasso L.
        • Gustinetti G.
        • et al.
        Missed opportunities to prevent mother-to-child transmission of HIV in Italy.
        HIV Med. 2019; 20: 330-336https://doi.org/10.1111/hiv.12728
      5. British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review): BHIVA guidelines for the management of HIV infection in pregnant women 2012 (2014 update).
        HIV Med. 2014; 15: 1-77https://doi.org/10.1111/hiv.12185
        • Antinori A
        • Di Biagio A
        • Marcotullio S
        • et al.
        Evidence-based renewal of the Italian guidelines for the use of antiretroviral agents and the diagnostic-clinical management of HIV-1 infected persons.
        New Microbiol. 2018; 41: 247-255
        • Cotter AM
        • Brookfield KF
        • Duthely LM
        • Gonzalez Quintero VH
        • Potter JE
        • O'Sullivan MJ
        Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy.
        Am J Obstet Gynecol. 2012; 207 (482.e1-5)https://doi.org/10.1016/j.ajog.2012.10.862
        • Chiappini E
        • Galli L
        • Giaquinto C
        • et al.
        Use of combination neonatal prophylaxis for the prevention of mother-to-child transmission of HIV infection in European high-risk infants.
        AIDS. 2013; 27: 991-1000https://doi.org/10.1097/QAD.0b013e32835cffb1
        • Rough K
        • Sun JW
        • Seage GR
        • et al.
        Zidovudine use in pregnancy and congenital malformations.
        AIDS. 2017; 31: 1733-1743https://doi.org/10.1097/QAD.0000000000001549
        • GRIGNOLO SARA
        • Agnello R
        • Gerbaldo D
        • et al.
        Pregnancy and neonatal outcomes among a cohort of HIV-infected women in a large Italian teaching hospital: a 30-year retrospective study.
        Epidemio Infect. 2017; (Published online): 1-12https://doi.org/10.1017/S095026881700053X