Venkatesh KK, et al. - Researchers aimed at describing the patterns and factors associated with mode of delivery among pregnant women with human immunodeficiency virus (HIV) infection in the United States in relation to evolving HIV-in-pregnancy guidelines. They noted that about half of the pregnant women with HIV infection underwent cesarean delivery. An increase in the rate of repeat cesarean deliveries was noted over time, whereas the rate of HIV-indicated cesarean deliveries decreased. Women at high risk of mother-to-child transmission underwent cesarean deliveries more frequently. Findings thereby highlight the significance of both early diagnosis and treatment of HIV infection in pregnancy and the option of vaginal delivery after cesarean among pregnant women with HIV infection.

Methods

• Researchers performed an analysis of two observational studies, Pediatric AIDS Clinical Trials Group and International Maternal Pediatric Adolescent AIDS Clinical Trials Network Protocol P1025.
• These studies enrolled pregnant women with HIV infection from 1998 to 2013 at more than 60 U.S. acquired immunodeficiency syndrome clinical research sites.
• They conducted multivariable analyses of factors associated with an HIV-indicated cesarean delivery (ie, for prevention of mother-to-child transmission) relative to other indications and compared them according to prespecified time periods of evolving HIV-in-pregnancy guidelines: 1998–1999, 2000–2008, and 2009–2013.

Results

• Researchers identified 6,444 pregnant women with HIV infection; 21% delivered in 1998–1999, 58% in 2000–2008, and 21% in 2009–2013; 3,025 (47%) delivered by cesarean.
• An increase in cesarean delivery from 30% in 1998 to 48% in 2013 was noted.
• Repeat cesarean deliveries increased from 16% in 1998 to 42% in 2013 among all cesarean deliveries; HIV-indicated cesarean deliveries peaked at 48% in 2004 and then dropped to 12% by 2013.
• In multivariable analyses, an HIV-indicated cesarean delivery was more frequently observed in association with an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, a plasma viral load 500 copies/mL or greater, and delivery between 37 and 40 weeks of gestation.
• Analyses by time period indicated that an HIV diagnosis during pregnancy, initiation of antiretroviral therapy in the third trimester, and a plasma viral load of 500 copies/mL or greater were progressively more likely to be associated with an HIV-indicated cesarean delivery over time.