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Background:  Since 1994 and the first introduction of ART in pregnant women mother-to-child transmission (MTCT) has dropped dramatically. First limited to zidovudine (AZT) monotherapy, bitherapies and tritherapies were then introduced. This study was designed to assess MTCT when ART is offered to HIV⁺ pregnant women, to assess compliance to therapy and its effects on MTCT.

Methods:  Our study is a monocentric prospective study, unrolling all HIV⁺ women delivering in our unit. CD4 count and viral load were checked at the beginning of pregnancy and at delivery. Infection in babies was assessed by viral culture or PCR techniques. Mothers’ treatments were divided in 3 groups: m onotherapy (A), bitherapies (B), tritherapies(C). All the women received AZT infusion at delivery; all the babies received ART for 6 weeks. Caesarean section was not systematically performed.

Results:  Between 1994 and 2004 we unrolled 381 women, 72% delivered vaginally, 28% by Caesarean section. Most HIV discoveries were recent (52% over the past year), which explains the low rate (23%) of pretreated women. At the beginning of pregnancy, mean CD4 count was 391, mean viral load 41,682 (range 0 to 407,147). At delivery mean CD4 count was 430, mean viral load was 1546 (0 to 43000), 58% were undetectable or < 100; only 4% were > 30,000. Group A comprised 14% of patients, group B 57%, and group C 28%: only 1% received no treatment. In group A, viral load was available in only 30% but was never undetectable at delivery. In group B, mean viral load dropped from 24,161 to 8900 with 62% undetectable or < 100. In group C, mean viral load dropped from 77,089 to 3229 with 61% undetectable or < 100. Overall, total lack of compliance was observed in only 7 % of the cases. Of the 371 evaluable babies, only 9 were contaminated (2.4%):  5 delivered vaginally, 4 by Caesarian section. All cultures and PCR were positive at birth, which accounts for early contamination before delivery. In 5 cases (55%), lack of mother’s compliance to treatment could contribute. Of the 4 other cases, 2 had premature birth with prolonged rupture of the membranes.

Conclusions:  According to CD4 count and viral load variations, very good treatment compliance (> 90%) was seen in HIV⁺ pregnant women, a much better result than in the general population. ART plays a major role to prevent MTCT and none of our babies was contaminated during delivery. However, good compliance should be emphasized to avoid more than half of the remaining MTCT. 

Keywords: Pregancy; ARV therapy; Mother to child transmission MTCT