499. Poor Virologic Control in Perinatally HIV-Infected Pregnant Women as Compared to Pregnant Women with Horizontally Acquired HIV
Session: Poster Abstract Session: HIV Testing and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: Children with perinatally acquired HIV- disease (PAD) are now of childbearing age and are increasingly facing the challenges of pregnancy. Women with PAD may not be comparable to women with horizontally acquired (HA) HIV with respect to disease status, viral resistance, treatment history and medication adherence. The two groups may also have different pregnancy complications and outcomes, and vertical transmission risk. We describe a group of pregnant women with PAD and compare them with an age matched pregnant HIV positive women with HA infection.

Methods:In this retrospective study all 17 PAD subjects with 21 pregnancies were matched and compared to 22 women with HA HIV with 24 pregnancies. All women got comprehensive HIV and prenatal care and delivered in the same hospital. Data abstracted included demographics, mode of delivery, disease status, drug resistance, CD4 counts, viral load (VL), and antiretroviral regimens (ARV) before, during and after pregnancy. CD4 counts and VL were an average of all values one year antepartum, during the 3 trimesters, and one year postpartum. Newborn data included gestational age, and perinatal history. 

Results:There were 10 Hispanic (H), 5 African-American (AA), and 2 Caucasian (C) women in the PAD group; and 13 AA, 8 H and 1 C in the HA group. The mean age in the two groups was 21 and 22 y, respectively. There was one case of maternal-infant transmission in the PAD group. All women were treated with ZDV/3TC and a PI and or NNRTI except two who received only ZDV/3TC/ABC. In the PAD group there were 8 vaginal deliveries as opposed to 18 in the HA cohort. In the PAD group the median viral load was consistently higher before and during the pregnancy, but comparable at delivery. During the first trimester postpartum, there was rebound viremia in both groups.  However, the HA group had a tendency to return to baseline VL, while the PAD group remained persistently viremic. CD4 counts were consistently and statistically lower in the PAD group. 

Conclusion: There was one case of vertical HIV transmission and we are troubled by the VL rises in the first two trimesters and in the postpartum periods in the PAD group. Sustained virologic suppression is rarely achieved in women with PAD, and this may have long term effects on maternal and infant health.


Subject Category: H. HIV/AIDS and other retroviruses

Zohaib Sohail, MD1, Joanna Dobroszycki, M.D.1, Michael Rosenberg, M.D. Ph.D1, Mindy Katz, MD2, Aileen Steiner, FNP3, Andrew Wiznia, MD1 and Jacobo Abadi, M.D.1, (1)Pediatrics/HIV, Jacobi Medical Center, Bronx, NY, (2)Jacobi Medical Center, Bronx, NY, (3)HIV, Jacobi Medical Center, Bronx, NY

Disclosures:

Z. Sohail, None

J. Dobroszycki, None

M. Rosenberg, None

M. Katz, None

A. Steiner, None

A. Wiznia, None

J. Abadi, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.