The HIV-infected infant’s mother had an HIV VL of 11 534 copies/mL at booking at 29 weeks, and she started a PI-based HAART regimen at 29 weeks. Her HIV VL at 36 weeks was 180 copies/mL and she delivered by elective Caesarean section at 38 weeks. The HIV-infected infant was asymptomatic and was started on HAART within a month of delivery. She was well when last seen in clinic. Reassuringly, despite the difficult medical and social circumstances of this vulnerable group of young women with HIV infection and high rates of unplanned pregnancy, the obstetric DZNeP in vitro and virological outcomes were
favourable. This is consistent with previous studies [9,11,12,16] and with pregnancies in HIV-infected adults from the UK and Ireland . The overall HIV mother-to-child transmission rate was 1.5%. The percentage of women with an undetectable HIV VL at or closest to delivery was 58%, and 21% had preterm delivery (<37 weeks). The favourable outcome in this study may in part be explained by the multidisciplinary care the patients received. In all 12 centres, HIV-infected pregnant women were cared for by a team comprised of, at least, an
HIV specialist, obstetrician, paediatrician and specialist midwife, as per the British HIV Association pregnancy guidelines . Out of 67 pregnancies, 18 occurred in centres (three of 12) with dedicated adolescent HIV services; however, most of these pregnancies preceded the development of such specialist services. As other studies have reported [6,11], there were significant and complex
psychosocial problems among this group. About half (44%; 22 of 50) lived alone, 58% (36 of 62) had housing problems, PD-1/PD-L1 inhibitor drugs Orotidine 5′-phosphate decarboxylase 10% (five of 49) had a history of domestic violence, 45% (18 of 40) reported a history of sexual abuse and over half of the women (62%; 34 of 55) encountered financial difficulties. As seen in American teenagers with HIV infection , the majority of pregnancies in this group were unplanned. Previous studies showed that the rates of high-risk sexual behaviour among HIV-infected adolescents and young adults were substantial [4–10,19]. In this study we found a striking lack of documentation of contraception use (40%; 27 of 67), past history of STIs (31%; 21 of 67) and date of the latest STI screen (46%; 31 of 67) in a significant proportion of patients. It is of particular concern that only 35% of the women (14 of 40) used condoms and 65% (26 of 40) used no contraception at all, with implications for onward HIV transmission and further unplanned pregnancy. Furthermore, although approximately half the patients were documented as having received advice regarding contraception post delivery, a quarter conceived within 12 months after delivery, of whom 53% (nine of 17) had not received contraception advice. The vast majority (88%) of pregnancies after delivery were unplanned. A limitation of this study is inherent to retrospective medical case note review.