Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting

Data From the Italian Register for HIV-1 Infection in Children

Elena Chiappini, Luisa Galli, Catiuscia Lisi, Clara Gabiano, Susanna Esposito, Vania Giacomet, Carlo Giaquinto, Osvalda Rampon, Raffaele Badolato, Orazio Genovese, Wilma Buffolano, Patrizia Osimani, Monica Cellini, Stefania Bernardi, Anna Maccabruni, Icilio Dodi, Filippo Salvini, Giacomo Faldella, Michele Quercia, Cristina Gotta & 6 others Marco Rabusin, Fabio Natale, Antonio Mazza, Mara Merighi, Pier-Angelo Tovo, Maurizio de Martino

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries.

OBJECTIVES: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission.

METHODS: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses.

RESULTS: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed.

CONCLUSIONS: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.

Original languageEnglish
Pages (from-to)54-61
Number of pages8
JournalJournal of acquired immune deficiency syndromes (1999)
Volume79
Issue number1
DOIs
Publication statusPublished - Sep 1 2018

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HIV Infections
HIV-1
Mothers
Viral Load
Premature Infants
Italy
Birth Rate
Infection
Breast Feeding
Multivariate Analysis
Logistic Models
Regression Analysis
Observation
Safety
Pregnancy

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Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting : Data From the Italian Register for HIV-1 Infection in Children. / Chiappini, Elena; Galli, Luisa; Lisi, Catiuscia; Gabiano, Clara; Esposito, Susanna; Giacomet, Vania; Giaquinto, Carlo; Rampon, Osvalda; Badolato, Raffaele; Genovese, Orazio; Buffolano, Wilma; Osimani, Patrizia; Cellini, Monica; Bernardi, Stefania; Maccabruni, Anna; Dodi, Icilio; Salvini, Filippo; Faldella, Giacomo; Quercia, Michele; Gotta, Cristina; Rabusin, Marco; Natale, Fabio; Mazza, Antonio; Merighi, Mara; Tovo, Pier-Angelo; de Martino, Maurizio.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 79, No. 1, 01.09.2018, p. 54-61.

Research output: Contribution to journalArticle

Chiappini, E, Galli, L, Lisi, C, Gabiano, C, Esposito, S, Giacomet, V, Giaquinto, C, Rampon, O, Badolato, R, Genovese, O, Buffolano, W, Osimani, P, Cellini, M, Bernardi, S, Maccabruni, A, Dodi, I, Salvini, F, Faldella, G, Quercia, M, Gotta, C, Rabusin, M, Natale, F, Mazza, A, Merighi, M, Tovo, P-A & de Martino, M 2018, 'Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting: Data From the Italian Register for HIV-1 Infection in Children', Journal of acquired immune deficiency syndromes (1999), vol. 79, no. 1, pp. 54-61. https://doi.org/10.1097/QAI.0000000000001774
Chiappini, Elena ; Galli, Luisa ; Lisi, Catiuscia ; Gabiano, Clara ; Esposito, Susanna ; Giacomet, Vania ; Giaquinto, Carlo ; Rampon, Osvalda ; Badolato, Raffaele ; Genovese, Orazio ; Buffolano, Wilma ; Osimani, Patrizia ; Cellini, Monica ; Bernardi, Stefania ; Maccabruni, Anna ; Dodi, Icilio ; Salvini, Filippo ; Faldella, Giacomo ; Quercia, Michele ; Gotta, Cristina ; Rabusin, Marco ; Natale, Fabio ; Mazza, Antonio ; Merighi, Mara ; Tovo, Pier-Angelo ; de Martino, Maurizio. / Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting : Data From the Italian Register for HIV-1 Infection in Children. In: Journal of acquired immune deficiency syndromes (1999). 2018 ; Vol. 79, No. 1. pp. 54-61.
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abstract = "BACKGROUND: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries.OBJECTIVES: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission.METHODS: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses.RESULTS: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3{\%} (563/3078) in 1996{\%}-2003{\%} to 66.2{\%} (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3{\%} (56/857) after 2010, and it was largely (4.2{\%}) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9{\%} (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5{\%} (96/2783) in 1996-2003; 1.4{\%} (36/2480) in 2004-2010; and 1.1{\%} (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed.CONCLUSIONS: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.",
author = "Elena Chiappini and Luisa Galli and Catiuscia Lisi and Clara Gabiano and Susanna Esposito and Vania Giacomet and Carlo Giaquinto and Osvalda Rampon and Raffaele Badolato and Orazio Genovese and Wilma Buffolano and Patrizia Osimani and Monica Cellini and Stefania Bernardi and Anna Maccabruni and Icilio Dodi and Filippo Salvini and Giacomo Faldella and Michele Quercia and Cristina Gotta and Marco Rabusin and Fabio Natale and Antonio Mazza and Mara Merighi and Pier-Angelo Tovo and {de Martino}, Maurizio",
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TY - JOUR

T1 - Strategies for Prevention of Mother-to-Child Transmission Adopted in the "Real-World" Setting

T2 - Data From the Italian Register for HIV-1 Infection in Children

AU - Chiappini, Elena

AU - Galli, Luisa

AU - Lisi, Catiuscia

AU - Gabiano, Clara

AU - Esposito, Susanna

AU - Giacomet, Vania

AU - Giaquinto, Carlo

AU - Rampon, Osvalda

AU - Badolato, Raffaele

AU - Genovese, Orazio

AU - Buffolano, Wilma

AU - Osimani, Patrizia

AU - Cellini, Monica

AU - Bernardi, Stefania

AU - Maccabruni, Anna

AU - Dodi, Icilio

AU - Salvini, Filippo

AU - Faldella, Giacomo

AU - Quercia, Michele

AU - Gotta, Cristina

AU - Rabusin, Marco

AU - Natale, Fabio

AU - Mazza, Antonio

AU - Merighi, Mara

AU - Tovo, Pier-Angelo

AU - de Martino, Maurizio

PY - 2018/9/1

Y1 - 2018/9/1

N2 - BACKGROUND: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries.OBJECTIVES: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission.METHODS: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses.RESULTS: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed.CONCLUSIONS: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.

AB - BACKGROUND: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries.OBJECTIVES: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission.METHODS: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses.RESULTS: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed.CONCLUSIONS: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.

U2 - 10.1097/QAI.0000000000001774

DO - 10.1097/QAI.0000000000001774

M3 - Article

VL - 79

SP - 54

EP - 61

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 1

ER -