Diagnosis of HIV infection during pregnancy: Trends from a national cohort in Spain

Abstract

Objectives and design: We aimed to describe pregnancies among women who were diagnosed with HIV during pregnancy in a multicentre cohort.

Methods: We included antiretroviral (ART)-naïve women, aged 18-50 years, who were recruited into the Spanish CoRIS cohort between 2004 and 2022 and had been diagnosed with HIV during pregnancy.

Results: Of 2102 women, 185 (8.8%) were diagnosed with HIV during pregnancy, 51.2% of which were late presenters, and 25.4% and 9.2% were diagnosed during the second and third trimester, respectively. Women from Latin America (adjusted odds ratio [OR]: 4.97, 95% CI: 1.72; 14.35) and Sub-Saharan Africa (3.07, 1.11; 8.52) were more likely to be diagnosed after the first trimester compared to Spanish women. Overall, 95.7% initiated ART during pregnancy, at a median time of 2 days (interquartile range [IQR]: 0; 14) from enrolment. Over time, the use of emtricitabine+tenofovir disoproxil fumarate (and later emtricitabine+tenofovir alafenamide), as well as integrase strand transfer inhibitors, increased. Overall, 95.1% of pregnancies resulted in delivery (46.0% caesarean). At 36 weeks of pregnancy, 82.8% of women had an undetectable viral load (VL), rising from 71.7% in 2004-2008 to over 95% after 2013. Preterm birth and low birth weight occurred in 10% and 9.8% of deliveries, respectively, with one HIV perinatal transmission.

Conclusions: Among women diagnosed with HIV during pregnancy, half were late presenters, and one-third were diagnosed after the first trimester, with higher percentages among African and Latin American women. There was a high proportion of caesarean deliveries. Most women initiated ART promptly after cohort enrolment and achieved undetectable VL at the end of pregnancy.

Keywords: HIV infections; antiretroviral therapy; cohort studies; diagnosis; epidemiology; pregnancy.