“FEDERICO II” UNIVERSITY OF NAPLES PhD Program ... - FedOA

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Chapter 1. HIV infection in Campania region
Annalisa AGANGI
1.3. Our experience: Materials and Methods
• Type of study: This is a prospective cohort study;
• Inclusion criteria: The study population consisted of all HIV-infected pregnant
women attending the Antenatal Clinic of the Department of Obstetrics
and Gynecology of the University of Naples Federico II;
• Data collection for pregnant women: All HIV-infected women attended to
our Department were enrolled and follow with their infected and uninfected
children. The management of the pregnancies was based on standard protocols
that were progressively updated according to advances in clinical care
and treatment guidelines. Informed consent was obtained for the use of personal
data and no woman declined to enter the study. We recorded sociodemographic
data (date of birth, marital status, ethnic group, work), and information
about clinical status (current HIV staging according to the 1993
CDC classification symptoms and date of onset), maternal antiretroviral
therapy (ART) with details about the date of starting and adverse effects, virological
and immunological status(quantitative HIV-RNA PCR, total lymphocytes,
CD4 and CD8 cell counts), route of transmission, HIV status of
the partner, and concomitant infectious diseases (TORCH, Lue). Data on
pregnancy and neonatal outcomes were also recorded by our multidisclipinary
team constituted by obstetricians and pediatricians. The data collected
were entered into a Microsoft Access Database which holds all information
on child and maternal follow-up.
• Results: By December 2006, 230 deliveries in 159 women had been monitored.
The following were the main results we obtained:
1. Deliveries in HIV-infected women increased from 0.16% (4/2,499) of all
deliveries in 1985 to 0.73% (15/2042) in 2006;
2. The socio-demographic profile of the women changed greatly over the
study period. There was a shift from injecting drug use to heterosexual
contact as the main transmission route, and an increased proportion of
foreign women;
3. The proportion of infected pregnant women receiving antiretroviral
treatment increased from 27% (17/63) before 1996 to 81% (63/78) in
2006, with a corresponding decrease in the mother-to-child transmission
rate from 36% (16/44) to 0.6% (1/157). Similar changes in the overall
scenario of HIV and pregnancy are occurring in various parts of the
world.
This work concluded with the publication of a paper on an international journal
as reported above.