Journal of Acquired Immune Deficiency Syndromes
Volume 79, Issue 1, 2018, Pages 54-61

Strategies for prevention of mother-to-child transmission adopted in the "real-world" setting: Data from the Italian register for HIV-1 infection in children (Article)

Chiappini E.* , Galli L. , Lisi C. , Gabiano C. , Esposito S. , Giacomet V. , Giaquinto C. , Rampon O. , Badolato R. , Genovese O. , Buffolano W. , Osimani P. , Cellini M. , Bernardi S. , MacCabruni A. , Dodi I. , Salvini F. , Faldella G. , Quercia M. , Gotta C. , Rabusin M. , Natale F. , Mazza A. , Merighi M. , Tovo P.-A. , De Martino M.
  • a Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children University Hospital, Viale Pieraccini 24, Florence, 50100, Italy, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Firenze, Italy
  • b Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children University Hospital, Viale Pieraccini 24, Florence, 50100, Italy, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Firenze, Italy
  • c Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children University Hospital, Viale Pieraccini 24, Florence, 50100, Italy, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Firenze, Italy
  • d Paediatric Unit, Department of Public Health and Paediatric Sciences, University of Turin, Regina Margherita Children's University Hospital, Turin, Italy
  • e Department of Surgical and Biomedical Sciences, Paediatric Clinic, University of Studies of Perugia, Perugia, Italy
  • f Unit of Paediatric Infectious Disease, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy
  • g Department of Women and Child Health, University of Padova, Padova, Italy
  • h Department of Women and Child Health, University of Padova, Padova, Italy
  • i Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
  • j Institute of Pediatrics, Catholic University of Sacred Heart, Gemelli Hospital, Rome, Italy
  • k Pediatric Infectious Diseases Unit, Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
  • l Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy
  • m Division of Pediatric Oncology, Azienda Ospedaliero-Universitaria di Modena Modena, Italy
  • n Department of Pediatric and Immunology Bambino Gesù, University Children's Hospital, Rome, Italy
  • o Department on Internal Medicine and Therapeutics, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Pavia, Italy
  • p Department of Paediatrics, Parma University Hospital, Parma, Italy
  • q Department of Paediatrics, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy
  • r Department of Preventive Pediatric and Neonatology, St Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy
  • s Department of Neonatology, NICU, Policlinico University Hospital, Bari, Italy
  • t Infectious Disease Unit, Ospedale Policlinico San Martino, Genova, Italy
  • u Department of Paediatrics and Bureau for International Health, Istituto per l'Infanzia Burlo Garofolo, Trieste, Italy
  • v Department of Pediatrics and Child Neuropsychiatry, La Sapienza University of Rome, Rome, Italy
  • w Paediatic Unit S. Chiara Hospital, Trento, Italy
  • x Department of Infectious Diseases, School of Medicine, University of Verona, Verona, Italy
  • y Paediatric Unit, Department of Public Health and Paediatric Sciences, University of Turin, Regina Margherita Children's University Hospital, Turin, Italy
  • z Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children University Hospital, Viale Pieraccini 24, Florence, 50100, Italy, Department of Paediatric Medicine, Anna Meyer Children's University Hospital, Firenze, Italy

Abstract

Background: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries. Objectives: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission. Methods: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses. Results: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed. Conclusions: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor. © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Author Keywords

Children HIV antiretroviral drugs prophylaxis mother-to-child transmission rate

Index Keywords

prospective study immigrant HIV Infections Registries Human immunodeficiency virus infection register human priority journal high income country Humans male female Infant risk factor pregnancy high risk population prevention and control isolation and purification Article prophylaxis adult major clinical study Infectious Disease Transmission, Vertical HIV-1 lamivudine antiretroviral therapy virus load lopinavir plus ritonavir nevirapine prematurity Human immunodeficiency virus 1 infection vaginal delivery Human immunodeficiency virus 1 zidovudine Italy single drug dose vertical transmission didanosine cesarean section Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85057200441&doi=10.1097%2fQAI.0000000000001774&partnerID=40&md5=954ebb86eb33052636a6e9feab5c73da
DOI: 10.1097/QAI.0000000000001774
ISSN: 15254135
Cited by: 1
Original Language: English