Intrapartum use of zidovudine in a large cohort of pregnant women living with HIV in Italy
Copyright © 2022. Published by Elsevier Ltd..
BACKGROUND: Intravenous administration of zidovudine (ZDV) during labour is a key step for vertical HIV transmission (VT) prevention, but there is no evidence of benefit when maternal HIV-RNA at delivery is <50 copies/mL. The aim of this study is evaluating the appropriateness of intrapartum ZDV use in Italy.
METHODS: Observational study including mother-infant pairs with perinatal HIV exposure during 2002-2019, enrolled in the Italian Register for HIV Infection in Children. Univariable and multivariable logistic regression were used to evaluate factors associated with VT.
RESULTS: A total of 3,861 infants, born from 3,791 pregnancies were included. The frequency of ZDV use was 79.9%, 92.1%, 93.7% and 92.8% when HIV-RNA was not available, ≥400 copies, between 50 and 399 copies, and <50 copies/mL. Thirty-three out of 3861 (0.85%) infants were subsequently diagnosed with HIV, 25/3861 (0.6%) of them born to mothers receiving intrapartum ZDV, and 31 (93.9%) to mothers with HIV-RNA ≥50 copies/mL or not available. In women with HIV-RNA < 50 copies/mL, ART discontinuation during pregnancy was the strongest risk factor for VT (odds ratio, OR, 23.1, 95%CI 2.4-219.3), while a higher gestational age (OR 0.6, 95%CI 0.4-0.8) and PEP administration to the newborn (aOR 0.004, 95%CI <0.0001-0.4) were protective factors. Intrapartum ZDV administration did not influence the final outcome in this group.
CONCLUSIONS: In ART era, more transmission events may occur in utero, limiting value of intrapartum ZDV, particularly for women with suppressed HIV-RNA load. More attention to the HIV-RNA testing of mothers before delivery may avoid unnecessary ZDV use.
Medienart: |
E-Artikel |
---|
Erscheinungsjahr: |
2022 |
---|---|
Erschienen: |
2022 |
Enthalten in: |
Zur Gesamtaufnahme - volume:85 |
---|---|
Enthalten in: |
The Journal of infection - 85(2022), 5 vom: 01. Nov., Seite 565-572 |
Sprache: |
Englisch |
---|
Links: |
---|
Themen: |
4B9XT59T7S |
---|
Anmerkungen: |
Date Completed 18.10.2022 Date Revised 05.12.2022 published: Print-Electronic Citation Status MEDLINE |
---|
doi: |
10.1016/j.jinf.2022.08.009 |
---|
funding: |
|
---|---|
Förderinstitution / Projekttitel: |
|
PPN (Katalog-ID): |
NLM345059298 |
---|
LEADER | 01000naa a22002652 4500 | ||
---|---|---|---|
001 | NLM345059298 | ||
003 | DE-627 | ||
005 | 20231226024217.0 | ||
007 | cr uuu---uuuuu | ||
008 | 231226s2022 xx |||||o 00| ||eng c | ||
024 | 7 | |a 10.1016/j.jinf.2022.08.009 |2 doi | |
028 | 5 | 2 | |a pubmed24n1150.xml |
035 | |a (DE-627)NLM345059298 | ||
035 | |a (NLM)35987392 | ||
035 | |a (PII)S0163-4453(22)00475-3 | ||
040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
041 | |a eng | ||
100 | 1 | |a Taramasso, Lucia |e verfasserin |4 aut | |
245 | 1 | 0 | |a Intrapartum use of zidovudine in a large cohort of pregnant women living with HIV in Italy |
264 | 1 | |c 2022 | |
336 | |a Text |b txt |2 rdacontent | ||
337 | |a ƒaComputermedien |b c |2 rdamedia | ||
338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
500 | |a Date Completed 18.10.2022 | ||
500 | |a Date Revised 05.12.2022 | ||
500 | |a published: Print-Electronic | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2022. Published by Elsevier Ltd. | ||
520 | |a BACKGROUND: Intravenous administration of zidovudine (ZDV) during labour is a key step for vertical HIV transmission (VT) prevention, but there is no evidence of benefit when maternal HIV-RNA at delivery is <50 copies/mL. The aim of this study is evaluating the appropriateness of intrapartum ZDV use in Italy | ||
520 | |a METHODS: Observational study including mother-infant pairs with perinatal HIV exposure during 2002-2019, enrolled in the Italian Register for HIV Infection in Children. Univariable and multivariable logistic regression were used to evaluate factors associated with VT | ||
520 | |a RESULTS: A total of 3,861 infants, born from 3,791 pregnancies were included. The frequency of ZDV use was 79.9%, 92.1%, 93.7% and 92.8% when HIV-RNA was not available, ≥400 copies, between 50 and 399 copies, and <50 copies/mL. Thirty-three out of 3861 (0.85%) infants were subsequently diagnosed with HIV, 25/3861 (0.6%) of them born to mothers receiving intrapartum ZDV, and 31 (93.9%) to mothers with HIV-RNA ≥50 copies/mL or not available. In women with HIV-RNA < 50 copies/mL, ART discontinuation during pregnancy was the strongest risk factor for VT (odds ratio, OR, 23.1, 95%CI 2.4-219.3), while a higher gestational age (OR 0.6, 95%CI 0.4-0.8) and PEP administration to the newborn (aOR 0.004, 95%CI <0.0001-0.4) were protective factors. Intrapartum ZDV administration did not influence the final outcome in this group | ||
520 | |a CONCLUSIONS: In ART era, more transmission events may occur in utero, limiting value of intrapartum ZDV, particularly for women with suppressed HIV-RNA load. More attention to the HIV-RNA testing of mothers before delivery may avoid unnecessary ZDV use | ||
650 | 4 | |a Journal Article | |
650 | 4 | |a Observational Study | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
650 | 4 | |a HIV | |
650 | 4 | |a U=U | |
650 | 4 | |a peripartum | |
650 | 4 | |a vertical transmission | |
650 | 4 | |a zidovudine | |
650 | 7 | |a Anti-HIV Agents |2 NLM | |
650 | 7 | |a Zidovudine |2 NLM | |
650 | 7 | |a 4B9XT59T7S |2 NLM | |
700 | 1 | |a Bovis, Francesca |e verfasserin |4 aut | |
700 | 1 | |a Di Biagio, Antonio |e verfasserin |4 aut | |
700 | 1 | |a Mignone, Federica |e verfasserin |4 aut | |
700 | 1 | |a Giaquinto, Carlo |e verfasserin |4 aut | |
700 | 1 | |a Tagliabue, Claudia |e verfasserin |4 aut | |
700 | 1 | |a Giacomet, Vania |e verfasserin |4 aut | |
700 | 1 | |a Genovese, Orazio |e verfasserin |4 aut | |
700 | 1 | |a Chiappini, Elena |e verfasserin |4 aut | |
700 | 1 | |a Salomè, Serena |e verfasserin |4 aut | |
700 | 1 | |a Badolato, Raffaele |e verfasserin |4 aut | |
700 | 1 | |a Carloni, Ines |e verfasserin |4 aut | |
700 | 1 | |a Cellini, Monica |e verfasserin |4 aut | |
700 | 1 | |a Dodi, Icilio |e verfasserin |4 aut | |
700 | 1 | |a Bossi, Grazia |e verfasserin |4 aut | |
700 | 1 | |a Allodi, Alessandra |e verfasserin |4 aut | |
700 | 1 | |a Bernardi, Stefania |e verfasserin |4 aut | |
700 | 1 | |a Consolini, Rita |e verfasserin |4 aut | |
700 | 1 | |a Dedoni, Maurizio |e verfasserin |4 aut | |
700 | 1 | |a Banderali, Giuseppe |e verfasserin |4 aut | |
700 | 1 | |a Mazza, Antonio |e verfasserin |4 aut | |
700 | 1 | |a Pruccoli, Giulia |e verfasserin |4 aut | |
700 | 1 | |a Rampon, Osvalda |e verfasserin |4 aut | |
700 | 1 | |a Erba, Paola |e verfasserin |4 aut | |
700 | 1 | |a Di Pietro, Giada |e verfasserin |4 aut | |
700 | 1 | |a Montagnani, Carlotta |e verfasserin |4 aut | |
700 | 1 | |a Capasso, Letizia |e verfasserin |4 aut | |
700 | 1 | |a Dotta, Laura |e verfasserin |4 aut | |
700 | 1 | |a Zallocco, Federica |e verfasserin |4 aut | |
700 | 1 | |a De Martino, Maurizio |e verfasserin |4 aut | |
700 | 1 | |a Lisi, Catiuscia |e verfasserin |4 aut | |
700 | 1 | |a Tovo, Pier Angelo |e verfasserin |4 aut | |
700 | 1 | |a Bassetti, Matteo |e verfasserin |4 aut | |
700 | 1 | |a Gabiano, Clara |e verfasserin |4 aut | |
700 | 1 | |a Galli, Luisa |e verfasserin |4 aut | |
700 | 0 | |a Italian Register for HIV Infection in Children |e verfasserin |4 aut | |
773 | 0 | 8 | |i Enthalten in |t The Journal of infection |d 1982 |g 85(2022), 5 vom: 01. Nov., Seite 565-572 |w (DE-627)NLM012791822 |x 1532-2742 |7 nnns |
773 | 1 | 8 | |g volume:85 |g year:2022 |g number:5 |g day:01 |g month:11 |g pages:565-572 |
856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.jinf.2022.08.009 |3 Volltext |
912 | |a GBV_USEFLAG_A | ||
912 | |a GBV_NLM | ||
951 | |a AR | ||
952 | |d 85 |j 2022 |e 5 |b 01 |c 11 |h 565-572 |