Prenatal testing and the risk of vertical transmission

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For pregnant women with HIV infection, invasive prenatal testing does not increase the risk of vertical transmission, found an Italian study.

Medical Xpress reports that Dr Marco Floridia, from the Istituto Superiore di Sanità in Rome, and colleagues conducted an observational study among pregnant women with HIV to examine the rates of amniocentesis and chorionic villus sampling and the outcomes associated with those procedures.

Data were examined for 2,065 pregnancies in women with HIV from The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy.

The researchers found that 5.5% of participants underwent invasive testing. In 87.6% of cases, the procedures were conducted under antiretroviral treatment, with the proportion of tests performed under highly active antiretroviral therapy (HAART) increasing significantly over time (100% in 2011 to 2015). There were three intrauterine deaths (2.6%), and 14 pregnancies were terminated because of the presence of foetal anomalies. Among the 88 live newborns with information available on HIV status, there were two HIV transmissions (2.3%). Among women who were on HAART at the time of invasive testing, there was no HIV transmission, and there were no cases after 2005.

“The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment,” the authors write.

Abstract
Objectives: To assess in pregnant women with HIV the rates of amniocentesis and chorionic villus sampling (CVS), and the outcomes associated with such procedures.
Design: Observational study. Data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy were used.
Setting: University and hospital clinics.
Population: Pregnant women with HIV.
Methods: Temporal trends were analysed by analysis of variance and by the Chi-square test for trend. Quantitative variables were compared by Student’s t-test and categorical data by the Chi-square test, with odds ratios and 95% confidence intervals calculated.
Main outcome measures: Rate of invasive testing, intrauterine death, HIV transmission.
Results: Between 2001 and 2015, among 2065 pregnancies in women with HIV, 113 (5.5%) had invasive tests performed. The procedures were conducted under antiretroviral treatment in 99 cases (87.6%), with a significant increase over time in the proportion of tests performed under highly active antiretroviral therapy (HAART) (100% in 2011–2015). Three intrauterine deaths were observed (2.6%), and 14 pregnancies were terminated because of fetal anomalies. Among 96 live newborns, eight had no information available on HIV status. Among the remaining 88 cases with either amniocentesis (n = 75), CVS (n = 12), or both (n = 1), two HIV transmissions occurred (2.3%). No HIV transmission occurred among the women who were on HAART at the time of invasive testing, and none after 2005.
Conclusions: The findings reinforce the assumption that invasive prenatal testing does not increase the risk of HIV vertical transmission among pregnant women under suppressive antiretroviral treatment.

Authors
M Floridia, G Masuelli, A Meloni, I Cetin, E Tamburrini, AF Cavaliere, S Dalzero, M Sansone, S Alberico, B Guerra, A Spinillo, M Chiadò Fiorio Tin, M Ravizza

Medical Xpress material
BJOG: An International Journal of Obstetrics & Gynaecology abstract


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