Evolving treatment implementation among HIV-infected pregnant women and their partners: results from a national surveillance study in Italy, 2001-2015

Marco Floridia, Valentina Frisina, Marina Ravizza, Anna Maria Marconi, Carmela Pinnetti, Irene Cetin, Matilde Sansone, Atim Molinari, Francesca Cervi, Alessandra Meloni, Kety Luzi, Giulia Masuelli, Enrica Tamburrini, Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The current global and national indications for antiretroviral treatment (ART, usually triple combination therapy) in adolescent and adults, including pregnant women, recommend early ART before immunologic decline, pre-exposure chemoprophylaxis (PrEP), and treatment of HIV-negative partners in serodiscordant couples. There is limited information on the implementation of these recommendations among pregnant women with HIV and their partners.

METHODS: The present analysis was performed in 2016, using data from clinical records of pregnant women with HIV, followed between 2001 and 2015 at hospital or university clinics within a large, nationally representative Italian cohort study. The study period was divided in three intervals of five years each (2001-2005, 2006-2010, 2011-2015), and the analysis evaluated temporal trends in rates of HIV diagnosis in pregnancy, maternal antiretroviral treatment at conception, prevalence of HIV infection among partners of pregnant women with HIV, and proportion of seronegative and seropositive male partners receiving antiretroviral treatment.

RESULTS: The analysis included 2755 pregnancies in women with HIV. During the three time intervals considered the rate of HIV diagnosis in pregnancy (overall 23.3%), and the distribution of HIV status among male partners (overall 48.7% HIV-negative, 28.6% HIV-positive and 22.8% unknown) remained substantially unchanged. Significant increases were observed in the proportion of women with HIV diagnosed before pregnancy who were on antiretroviral treatment at conception (from 62.0% in 2001-2005 to 81.3% in 2011-2015,P < 0.001), and in the proportion of HIV-positive partners on antiretroviral treatment (from 73.3% in 2001-2005 to 95.8% in 2011-2015,P = 0.002). Antiretroviral treatment was administered in 99.1% of the pregnancies that did not end early because of miscarriage, termination, or intrauterine death, and in 75.3% of those not ending in a live birth. No implementation of antiretroviral treatment was introduced among male HIV-negative partners.

CONCLUSIONS: The results suggest good implementation of antiretroviral treatment among HIV-positive women and their HIV-positive partners, but no implementation, even in recent years, of Pre-Exposure Prophylaxis (PrEP) among uninfected male partners. Further studies should assess the determinants of this occurrence and clarify the attitudes and the potential barriers to PrEP use.

Original languageEnglish
Pages (from-to)010407
JournalJournal of Global Health
Volume7
Issue number1
DOIs
Publication statusPublished - Jun 2017

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Italy
Pregnant Women
HIV
Therapeutics
Pregnancy
Chemoprevention
Live Birth
Spontaneous Abortion
HIV Infections
Cohort Studies
Mothers

Keywords

  • Adolescent
  • Adult
  • Anti-HIV Agents/administration & dosage
  • Cohort Studies
  • Female
  • Fertilization/drug effects
  • HIV Infections/diagnosis
  • Humans
  • Infectious Disease Transmission, Vertical/prevention & control
  • Italy/epidemiology
  • Male
  • Pre-Exposure Prophylaxis/methods
  • Pregnancy
  • Pregnancy Complications, Infectious/drug therapy
  • Pregnancy Outcome/epidemiology
  • Prevalence
  • Sexual Partners

Cite this

Evolving treatment implementation among HIV-infected pregnant women and their partners : results from a national surveillance study in Italy, 2001-2015. / Floridia, Marco; Frisina, Valentina; Ravizza, Marina; Marconi, Anna Maria; Pinnetti, Carmela; Cetin, Irene; Sansone, Matilde; Molinari, Atim; Cervi, Francesca; Meloni, Alessandra; Luzi, Kety; Masuelli, Giulia; Tamburrini, Enrica; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy.

In: Journal of Global Health, Vol. 7, No. 1, 06.2017, p. 010407.

Research output: Contribution to journalArticle

Floridia, M, Frisina, V, Ravizza, M, Marconi, AM, Pinnetti, C, Cetin, I, Sansone, M, Molinari, A, Cervi, F, Meloni, A, Luzi, K, Masuelli, G, Tamburrini, E & Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy 2017, 'Evolving treatment implementation among HIV-infected pregnant women and their partners: results from a national surveillance study in Italy, 2001-2015', Journal of Global Health, vol. 7, no. 1, pp. 010407. https://doi.org/10.7189/jogh.07.010407
Floridia, Marco ; Frisina, Valentina ; Ravizza, Marina ; Marconi, Anna Maria ; Pinnetti, Carmela ; Cetin, Irene ; Sansone, Matilde ; Molinari, Atim ; Cervi, Francesca ; Meloni, Alessandra ; Luzi, Kety ; Masuelli, Giulia ; Tamburrini, Enrica ; Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy. / Evolving treatment implementation among HIV-infected pregnant women and their partners : results from a national surveillance study in Italy, 2001-2015. In: Journal of Global Health. 2017 ; Vol. 7, No. 1. pp. 010407.
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title = "Evolving treatment implementation among HIV-infected pregnant women and their partners: results from a national surveillance study in Italy, 2001-2015",
abstract = "BACKGROUND: The current global and national indications for antiretroviral treatment (ART, usually triple combination therapy) in adolescent and adults, including pregnant women, recommend early ART before immunologic decline, pre-exposure chemoprophylaxis (PrEP), and treatment of HIV-negative partners in serodiscordant couples. There is limited information on the implementation of these recommendations among pregnant women with HIV and their partners.METHODS: The present analysis was performed in 2016, using data from clinical records of pregnant women with HIV, followed between 2001 and 2015 at hospital or university clinics within a large, nationally representative Italian cohort study. The study period was divided in three intervals of five years each (2001-2005, 2006-2010, 2011-2015), and the analysis evaluated temporal trends in rates of HIV diagnosis in pregnancy, maternal antiretroviral treatment at conception, prevalence of HIV infection among partners of pregnant women with HIV, and proportion of seronegative and seropositive male partners receiving antiretroviral treatment.RESULTS: The analysis included 2755 pregnancies in women with HIV. During the three time intervals considered the rate of HIV diagnosis in pregnancy (overall 23.3{\%}), and the distribution of HIV status among male partners (overall 48.7{\%} HIV-negative, 28.6{\%} HIV-positive and 22.8{\%} unknown) remained substantially unchanged. Significant increases were observed in the proportion of women with HIV diagnosed before pregnancy who were on antiretroviral treatment at conception (from 62.0{\%} in 2001-2005 to 81.3{\%} in 2011-2015,P < 0.001), and in the proportion of HIV-positive partners on antiretroviral treatment (from 73.3{\%} in 2001-2005 to 95.8{\%} in 2011-2015,P = 0.002). Antiretroviral treatment was administered in 99.1{\%} of the pregnancies that did not end early because of miscarriage, termination, or intrauterine death, and in 75.3{\%} of those not ending in a live birth. No implementation of antiretroviral treatment was introduced among male HIV-negative partners.CONCLUSIONS: The results suggest good implementation of antiretroviral treatment among HIV-positive women and their HIV-positive partners, but no implementation, even in recent years, of Pre-Exposure Prophylaxis (PrEP) among uninfected male partners. Further studies should assess the determinants of this occurrence and clarify the attitudes and the potential barriers to PrEP use.",
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author = "Marco Floridia and Valentina Frisina and Marina Ravizza and Marconi, {Anna Maria} and Carmela Pinnetti and Irene Cetin and Matilde Sansone and Atim Molinari and Francesca Cervi and Alessandra Meloni and Kety Luzi and Giulia Masuelli and Enrica Tamburrini and {Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy}",
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language = "English",
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TY - JOUR

T1 - Evolving treatment implementation among HIV-infected pregnant women and their partners

T2 - results from a national surveillance study in Italy, 2001-2015

AU - Floridia, Marco

AU - Frisina, Valentina

AU - Ravizza, Marina

AU - Marconi, Anna Maria

AU - Pinnetti, Carmela

AU - Cetin, Irene

AU - Sansone, Matilde

AU - Molinari, Atim

AU - Cervi, Francesca

AU - Meloni, Alessandra

AU - Luzi, Kety

AU - Masuelli, Giulia

AU - Tamburrini, Enrica

AU - Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy

PY - 2017/6

Y1 - 2017/6

N2 - BACKGROUND: The current global and national indications for antiretroviral treatment (ART, usually triple combination therapy) in adolescent and adults, including pregnant women, recommend early ART before immunologic decline, pre-exposure chemoprophylaxis (PrEP), and treatment of HIV-negative partners in serodiscordant couples. There is limited information on the implementation of these recommendations among pregnant women with HIV and their partners.METHODS: The present analysis was performed in 2016, using data from clinical records of pregnant women with HIV, followed between 2001 and 2015 at hospital or university clinics within a large, nationally representative Italian cohort study. The study period was divided in three intervals of five years each (2001-2005, 2006-2010, 2011-2015), and the analysis evaluated temporal trends in rates of HIV diagnosis in pregnancy, maternal antiretroviral treatment at conception, prevalence of HIV infection among partners of pregnant women with HIV, and proportion of seronegative and seropositive male partners receiving antiretroviral treatment.RESULTS: The analysis included 2755 pregnancies in women with HIV. During the three time intervals considered the rate of HIV diagnosis in pregnancy (overall 23.3%), and the distribution of HIV status among male partners (overall 48.7% HIV-negative, 28.6% HIV-positive and 22.8% unknown) remained substantially unchanged. Significant increases were observed in the proportion of women with HIV diagnosed before pregnancy who were on antiretroviral treatment at conception (from 62.0% in 2001-2005 to 81.3% in 2011-2015,P < 0.001), and in the proportion of HIV-positive partners on antiretroviral treatment (from 73.3% in 2001-2005 to 95.8% in 2011-2015,P = 0.002). Antiretroviral treatment was administered in 99.1% of the pregnancies that did not end early because of miscarriage, termination, or intrauterine death, and in 75.3% of those not ending in a live birth. No implementation of antiretroviral treatment was introduced among male HIV-negative partners.CONCLUSIONS: The results suggest good implementation of antiretroviral treatment among HIV-positive women and their HIV-positive partners, but no implementation, even in recent years, of Pre-Exposure Prophylaxis (PrEP) among uninfected male partners. Further studies should assess the determinants of this occurrence and clarify the attitudes and the potential barriers to PrEP use.

AB - BACKGROUND: The current global and national indications for antiretroviral treatment (ART, usually triple combination therapy) in adolescent and adults, including pregnant women, recommend early ART before immunologic decline, pre-exposure chemoprophylaxis (PrEP), and treatment of HIV-negative partners in serodiscordant couples. There is limited information on the implementation of these recommendations among pregnant women with HIV and their partners.METHODS: The present analysis was performed in 2016, using data from clinical records of pregnant women with HIV, followed between 2001 and 2015 at hospital or university clinics within a large, nationally representative Italian cohort study. The study period was divided in three intervals of five years each (2001-2005, 2006-2010, 2011-2015), and the analysis evaluated temporal trends in rates of HIV diagnosis in pregnancy, maternal antiretroviral treatment at conception, prevalence of HIV infection among partners of pregnant women with HIV, and proportion of seronegative and seropositive male partners receiving antiretroviral treatment.RESULTS: The analysis included 2755 pregnancies in women with HIV. During the three time intervals considered the rate of HIV diagnosis in pregnancy (overall 23.3%), and the distribution of HIV status among male partners (overall 48.7% HIV-negative, 28.6% HIV-positive and 22.8% unknown) remained substantially unchanged. Significant increases were observed in the proportion of women with HIV diagnosed before pregnancy who were on antiretroviral treatment at conception (from 62.0% in 2001-2005 to 81.3% in 2011-2015,P < 0.001), and in the proportion of HIV-positive partners on antiretroviral treatment (from 73.3% in 2001-2005 to 95.8% in 2011-2015,P = 0.002). Antiretroviral treatment was administered in 99.1% of the pregnancies that did not end early because of miscarriage, termination, or intrauterine death, and in 75.3% of those not ending in a live birth. No implementation of antiretroviral treatment was introduced among male HIV-negative partners.CONCLUSIONS: The results suggest good implementation of antiretroviral treatment among HIV-positive women and their HIV-positive partners, but no implementation, even in recent years, of Pre-Exposure Prophylaxis (PrEP) among uninfected male partners. Further studies should assess the determinants of this occurrence and clarify the attitudes and the potential barriers to PrEP use.

KW - Adolescent

KW - Adult

KW - Anti-HIV Agents/administration & dosage

KW - Cohort Studies

KW - Female

KW - Fertilization/drug effects

KW - HIV Infections/diagnosis

KW - Humans

KW - Infectious Disease Transmission, Vertical/prevention & control

KW - Italy/epidemiology

KW - Male

KW - Pre-Exposure Prophylaxis/methods

KW - Pregnancy

KW - Pregnancy Complications, Infectious/drug therapy

KW - Pregnancy Outcome/epidemiology

KW - Prevalence

KW - Sexual Partners

U2 - 10.7189/jogh.07.010407

DO - 10.7189/jogh.07.010407

M3 - Article

C2 - 28567279

VL - 7

SP - 010407

JO - Journal of Global Health

JF - Journal of Global Health

SN - 2047-2978

IS - 1

ER -