Vaginal deliveries increased in HIV women after European guideline changes

GLASGOW — Researchers reported an increase in vaginal delivery rates across Europe, from 17% to 52%, after most national guidelines were updated between 2001 and 2009 to recommend vaginal deliveries for HIV-positive women with undetectable or very low viral load.

The analysis focused on pooled data from women with HIV enrolled in the European Collaborative Study and the Swiss Mother and Child HIV Cohort Study. All women had a live birth from 2000 to 2010. Deliveries were classified as occurring before or after publication of guidelines recommending vaginal delivery in women with undetectable or low viral load, according to a study abstract.

Karoline Aebi-Popp, MD, of St. James’s Hospital in Dublin, reported data compiled on 2,530 mothers and 2,850 deliveries in 10 countries.

The mean age at time of delivery was 31 years. Sixteen percent of women reported history of IV drug use and 3% reported current IV drug use during pregnancy. One-third of all women received their HIV diagnosis during pregnancy, with 20% of women diagnosed as late as the third trimester. Nearly one-third of women conceived while on combination ART, 63% started therapy during pregnancy and 8% received no antenatal ART. The most common regimen used was protease inhibitor-based.

Although the rate of vaginal delivery increased from 17% to nearly half of all women studied after the guidelines, rates of emergency cesarean section remained relatively stable and elective cesarean section decreased accordingly, according to Aebi-Popp.

Fifty-two percent of all women achieved the aim of undetectable viral load during the 10-year analysis. This increased over time, from less than 10% to more than 75%, she said during her presentation.

“Forty-six percent of all women with undetectable viral load after the change of the guidelines still had cesarean section,” Aebi-Popp said. The researchers analyzed this in 82 deliveries. Aside from obvious reasons such as previous cesarean section or fetal and maternal indications, in 14 of 82 cases, the only reason for cesarean section was HIV infection. “Forty-one percent of those cesarean sections may have been avoided, according to new guidelines,” she said.

“There are missed opportunities to achieve full suppressed viral load at time of delivery and to deliver vaginally in HIV-infected women. Further evaluation of treatment regimens, adherence data and barriers to treatment is planned within these cohorts,” Aebi-Popp and colleagues wrote in the abstract.

For more information

Aebi-Popp K. #O322. Presented at: HIV11 Congress; Nov. 11-15, 2012; Glasgow.

Disclosure: Aebi-Popp reports no relevant financial disclosures.