Background:  Children with perinatally acquired HIV disease (PAHD) are now of childbearing age and are increasingly facing the challenges of pregnancy. Adolescents with PAHD are not comparable to women with horizontally acquired HIV with respect to age, disease status, viral resistance, treatment history, and medication adherence. The 2 groups may also differ with respect to complications and outcomes of pregnancy and the risk of vertical transmission. We describe a group of young pregnant women with PAHD and compare them with a cohort of pregnant HIV⁺ patients with horizontally acquired infection.

Methods:  In this retrospective study, all 9 PAHD subjects with 14 pregnancies were compared to 27 randomly selected women with horizontally acquired HIV with 32 pregnancies. All women received comprehensive HIV and prenatal care and delivered in the same hospital. Data abstracted from the medical records included demographics, mode of delivery, disease status, drug resistance, CD4% and absolute counts, viral load, and ART regimens before, during, and after pregnancy. CD4 counts and viral load were an average of all available values 1 year antepartum, during the 3 trimesters of pregnancy, and 1 year postpartum. Newborn data included gestational age and perinatal history.

Results:  The PAHD group included 6 Hispanics and 3 African Americans; the horizontally acquired group, 6 Hispanics and 21 African Americans. The mean ages in the 2 groups were 19 and 29 years, respectively. There were no cases of maternal-infant transmission in either group. All women were treated with zidovudine (ZDV)/lamivudine (3TC) and a protease inhibitor (PI) or a NNRTI, except 2 who received only ZDV/3TC/abacavir (ABC). In the PAHD group there were 2 vaginal deliveries (22%) as opposed to 20 (63%) in the horizontally acquired cohort. In the PAHD group the median viral load was consistently higher before and during the pregnancy. During the first month postpartum, there was rebound viremia in both groups.  However, the horizontally acquired group returned to baseline VIRAL LOAD in a month while the PAHD group remained persistently viremic. CD4% and absolute counts were consistently lower in the PAHD group.

Conclusions:  There were no cases of vertical HIV transmission, but we are troubled by the viral load increases in the first 2 trimesters and in the postpartum periods in the PAHD group. Sustained virologic suppression is rarely achieved in women with PAHD, and this may have long-term deleterious effects on maternal and infant health.