Another explanation could be that women with undiagnosed HIV infe

Another explanation could be that women with undiagnosed HIV infection, when they become pregnant, are not offered an HIV test and therefore the increase is merely a consequence of a lack of screening

and identification. The proportion of women on ART increased from 76% to 98% during the study period. The goal of ART is to normalize the CD4 cell count and suppress viral load to an undetectable level. In most studies, HIV RNA <1000 copies/mL is used as a measure of treatment success and as a reliable predictor of the risk of transmission, although the aim is to fully suppress viral replication. In our study, HIV RNA levels were available for 206 women, and of these 95% had HIV RNA <1000 copies/mL. The CD4 cell count seemed higher when ART was initiated before week 14, a finding partly explained by the large group of

find more women who were receiving optimal treatment by the time of conception. Low CD4 cell Cetuximab concentration count is an important risk factor for postnatal transmission [14]. However, as HIV-infected mothers in Denmark are advised against breastfeeding and as the CD4 count was >400 cells/μL at delivery in both groups, this finding is considered to have no clinical implications. Viral load, which usually declines quite rapidly after initiation of therapy, was not affected by timing of ART initiation. After 2006, approximately one-third of the HIV-infected women delivered vaginally, although as many as 81% of the women had undetectable viral load, and a vaginal delivery was therefore virologically appropriate for these women [15]. However, some

women who intended to deliver vaginally Parvulin were given a Caesarean section as prolonged vaginal deliveries are not recommended, which also explains the increase in acute Caesarean sections observed from 2005. In our study, 26% of children had haemoglobin concentrations <8.7 mmol/L. This might be explained by the use of prophylactic ZDV, which is known to be associated with anaemia (usually mild and reversible) [16–18]. Seventeen per cent (32 of 188) of the women delivered before week 37 of pregnancy, which corresponds to the findings of a recent British study where 14% of the births were premature for women on HAART compared with 10% for women on monotherapy or dual therapy [19]. Another large American study found an increased but declining risk of premature birth among infants born to HIV-infected women during 1989–2004 [20]. Although 67% of the women were aware of their HIV status prior to pregnancy and 66% of pregnancies were planned, only 29% received preconception counselling by an infectious disease specialist. In Denmark, fertility treatment has since 2002 been offered free of charge and is an important alternative for the HIV-infected couple. Preconception counselling should always be provided to fertile HIV-infected women, and specialists should bring up the subject of conception at regular intervals.

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