Resumen

Objectives: To describe the pregnancy outcomes and trends in prescription of antiretroviral treatments (ARTs) among women who were diagnosed with HIV during pregnancy in the CoRIS cohort. Methods: Among women aged 18-50 who were recruited in CoRIS between 2004 and 2022, we included those who were diagnosed with HIV during pregnancy. We described pregnancy outcomes and, among pregnancies resulting in a delivery, we described first-line antiretroviral treatments, and treatment outcomes: treatment persistence, reasons for treatment change and the proportion of women with undetectable viral load (VL) (= 50 copies/mL) at week 36 of pregnancy. Results: Among the 2,102 women included in CoRIS, we included 185 (8.8%) who were diagnosed with HIV infection after pregnancy, of which 82 (51.2%) were late presenters. Median gestational age at HIV diagnosis was 11.4 weeks (IQR: 9.1; 16), 121 (65.4%) were diagnosed in the first, 47 (25.4%) in the second and 17 (9.2%) in the third trimester of pregnancy. Among 185 pregnancies, 174 (94.1%) resulted in a delivery, 8 (4.3%) were voluntary terminated and 1 (0.5%) resulted in miscarriage. Among the deliveries, 94 (54.0%) were vaginal births, and 80 (46.0%) were caesarean deliveries. The proportion of caesarean has decreased over time: 40.91% in 2004-07, 43.7% in 2008-11, 65.2% in 2012-15, 28.9 in 2016-19 and 33.3% in 2020-2022. One (0.6%) infant was HIV-positive. Of the 174 women that had a delivery, 171 (98.3%) initiated ART during pregnancy, (28.1% in the first trimester although with a shift towards starting earlier over time). The figure shows initial ART regimens by year of pregnancy: over time, prescription of zidovudine/ lamivudine and protease inhibitors decreased and were gradually substituted by tenofovir/emtricitabine and integrase inhibitors. The median time to treatment change in a total of 29 (17%) pregnancies was 27.0 (IQR: 24.3;32.7) weeks from ART initiation and most frequent reasons for change were side effects (14, 8.2%) and simplification (6, 3.5%). The proportion of women with undetectable VL at week 36 was 82.8% and one (0.6%) infant was HIV-positive. Conclusions: Among women diagnosed with HIV during pregnancy, half were late presenters and one out of ten was diagnosed during the third trimester. There was a high proportion of caesarean deliveries. Trends in ART prescription reflect the changes in national clinical practice guidelines. Most women achieved undetectable viral load at the end of pregnancy