Thirty years of HIV pregnancies in French Guiana: prevention successes and remaining obstetrical challenges

IF 2.3 Q2 OBSTETRICS & GYNECOLOGY Frontiers in global women's health Pub Date : 2024-01-03 DOI:10.3389/fgwh.2023.1264837
Mathieu Nacher, Julie Blanc, Sébastien Rabier, A. Lucarelli, A. Adenis, C. Basurko, Alphonse Louis, Dominique Dotou, Malika Leneuve, Lindsay Osei, N. Elenga, N. Hcini
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Abstract

In a context of high HIV prevalence, poor pregnancy follow-up, frequent poverty, preeclampsia, and preterm delivery, we aimed to describe the characteristics and outcomes of pregnancies among women living with HIV in French Guiana.A retrospective cohort study was conducted on HIV-infected pregnancies enrolled between January 1st 1992 to 31st July 2022. Overall, there were 1,774 pregnancies in 881 women living with HIV.For 75.1% of pregnancies, the HIV diagnosis was already known before pregnancy and in 67.6% of women, HIV follow-up predated pregnancy. Nearly half of women, 49.6%, only had one pregnancy since having been diagnosed with HIV. Although most women received antiretroviral therapy during pregnancy, for those with the available information we found only 48.5% had an undetectable viral load at delivery. Overall, 15.3% of pregnancies ended with an abortion. There were a total of 110 newborns infected with HIV representing an overall transmission rate of 6.2% (110/1,771). Between 1993 and 2002, the transmission rate was 34%, between 2003 and 2012 it was 1.3%, and between 2013 and 2022 it was 0.7%. Overall, in Cayenne, since 2008, 106 of 581 HIV–infected pregnancies (18.2%) with available information were premature before 37 weeks of pregnancy; of these, 33 (5.7%) were very preterm deliveries and 73 (13.3%) were late preterm deliveries. Over time, in Cayenne, preterm delivery declined significantly.The present study emphasizes that, despite spectacular progress in reducing mother to child transmission, pregnancy outcomes among women living with HIV are still preoccupying with high incidence of preterm delivery and low birth weight. Teasing out what fraction is linked to HIV and what fraction is linked to social precariousness and poor follow-up was not possible in this study. Despite the high incidence of very preterm delivery recent progress suggests that coordination efforts to improve follow-up may also have improved obstetrical outcomes.
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法属圭亚那 30 年来的艾滋病毒妊娠:预防工作的成功和产科方面仍然存在的挑战
在法属圭亚那,艾滋病病毒感染率高、妊娠随访率低、贫困、先兆子痫和早产现象频发,在这种情况下,我们旨在描述感染艾滋病病毒的妇女的妊娠特征和妊娠结局。在 75.1%的孕妇中,艾滋病毒诊断结果在怀孕前就已知晓;在 67.6%的孕妇中,艾滋病毒随访在怀孕前就已开始。近一半的妇女(49.6%)在确诊感染艾滋病毒后只怀孕过一次。虽然大多数妇女在怀孕期间都接受了抗逆转录病毒治疗,但我们发现,在那些有相关信息的妇女中,只有 48.5% 在分娩时检测不到病毒载量。总体而言,15.3% 的孕妇以流产告终。共有 110 名新生儿感染了艾滋病毒,总传播率为 6.2%(110/1,771)。1993 至 2002 年间,传播率为 34%,2003 至 2012 年间为 1.3%,2013 至 2022 年间为 0.7%。总体而言,自2008年以来,在卡宴,581例感染艾滋病毒的孕妇中有106例(18.2%)在怀孕37周前早产;其中33例(5.7%)为极早产,73例(13.3%)为晚期早产。本研究强调,尽管在减少母婴传播方面取得了令人瞩目的进展,但感染艾滋病病毒的妇女的妊娠结局仍以早产和出生体重不足的高发生率而令人担忧。在这项研究中,不可能找出哪一部分与艾滋病毒有关,哪一部分与社会不稳定和随访不力有关。尽管极早产的发生率很高,但最近的进展表明,为改善后续工作而进行的协调努力也可能会改善产科结果。
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3.70
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0.00%
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审稿时长
13 weeks
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