Background and objective: Since 1994, when the PACTG 076 results were published, the rate of vertical transmission has decreased from 25% to 2%. Nowadays the prevalence of HIV infection in Catalan pregnant women is 0.17% yet it is 0.5% in our hospital. Our objectives were: to analyze the number of new cases of HIV infection by vertical transmission; to determine the importance of risk factors; to prove how important is to identify HIV-infected pregnant women; to determine the role of the rapid HIV-1 testing in labour room; and to detect mistakes in the prophylactic strategies.
Patients and method: One hundted and twenty four newborns from HIV-infected pregnant women born in Hospital del Mar were prospectively followed from 1996-2005. All them were separated in different groups in order to compare them.
Results: Eight children were infected, corresponding to 6.45%. In the group of newborns whose mothers were identified as infected during pregnancy, even with prophylactic measures well done, the transmission rate was 3.6% and it was 3.8% in the group born after 1999. When the prophylactic strategies were correct, 30% of pregnant women reached delivery with HIV RNA <1,000/ml copies. In the multivariate analysis, two variables were significant: amniorrhexis >4h and lack of identification of pregnant women as being HIV positive.
Conclusions: The identification of HIV-pregnant women has been crucial to avoid HIV mother-to-child transmission. Rapid HIV-1 testing in labour room is key to set up preventive strategies in order to avoid the infection in the newborn. Adequate prophylaxis percentages are still low and improvement is needed.