Elena Chiappini1,2, Luisa Galli1,2, Catiuscia Lisi1,2, Clara Gabiano3, Susanna Esposito4, Vania Giacomet5, Carlo Giaquinto6, Osvalda Rampon6, Raffaele Badolato7, Orazio Genovese8, Wilma Buffolano9, Patrizia Osimani10, Monica Cellini11, Stefania Bernardi12, Anna Maccabruni13, Icilio Dodi14, Filippo Salvini15, Giacomo Faldella16, Michele Quercia17, Cristina Gotta18, Marco Rabusin19, Fabio Natale20, Antonio Mazza21, Mara Merighi22, Pier-Angelo Tovo3, Maurizio de Martino1,2. 1. Paediatric Infectious Diseases Unit, Department of Health Sciences, Anna Meyer Children University Hospital, Firenze, Italy. 2. Department of Paediatric Medicine Anna Meyer Children's University Hospital, Firenze, Italy. 3. Paediatric Unit, Department of Public Health and Paediatric Sciences, University of Turin, Regina Margherita Children's University Hospital, Turin, Italy. 4. Department of Surgical and Biomedical Sciences, Paediatric Clinic, University of Studies of Perugia, Perugia, Italy. 5. Unit of Paediatric Infectious Disease, Department of Paediatrics, Luigi Sacco Hospital, University of Milan, Milan, Italy. 6. Department of Women and Child Health, University of Padova, Padova, Italy. 7. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 8. Institute of Pediatrics, Catholic University of Sacred Heart, Gemelli Hospital, Rome, Italy. 9. Pediatric Infectious Diseases Unit, Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy. 10. Department of Mother and Child Health, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy. 11. Division of Pediatric Oncology, Azienda Ospedaliero-Universitaria di Modena Modena, Italy. 12. Department of Pediatric and Immunology "Bambino Gesù," University Children's Hospital, Rome, Italy. 13. Department on Internal Medicine and Therapeutics, IRCCS Policlinico "S. Matteo" Foundation, University of Pavia, Pavia, Italy. 14. Department of Paediatrics, Parma University Hospital, Parma, Italy. 15. Department of Paediatrics, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy. 16. Department of Preventive Pediatric and Neonatology, St Orsola Malpighi General Hospital, University of Bologna, Bologna, Italy. 17. Department of Neonatology and NICU, Policlinico University Hospital, Bari, Italy. 18. Infectious Disease Unit, Ospedale Policlinico San Martino, Genova, Italy. 19. Department of Paediatrics and Bureau for International Health, Istituto per l'Infanzia "Burlo Garofolo," Trieste, Italy. 20. Department of Pediatrics and Child Neuropsychiatry, "La Sapienza" University of Rome, Rome, Italy. 21. Paediatic Unit, "S. Chiara" Hospital, Trento, Italy. 22. Department of Infectious Diseases, School of Medicine, University of Verona, Verona, Italy.
Abstract
BACKGROUND: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries. OBJECTIVES: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission. METHODS: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses. RESULTS: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed. CONCLUSIONS: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.
BACKGROUND: Strategies for prevention of HIV-1 mother-to-child transmission (PMTCT) have been continuously optimized. However, cases of vertical transmission continue to occur in high-income countries. OBJECTIVES: To investigate changes in PMTCT strategies adopted by Italian clinicians over time and to evaluate risk factors for transmission. METHODS: Data from mother-child pairs prospectively collected by the Italian Register, born in Italy in 1996-2016, were analyzed. Risk factors for MTCT were explored by logistic regression analyses. RESULTS: Six thousand five hundred three children (348 infections) were included. In our cohort, the proportion of children born to foreign mothers increased from 18.3% (563/3078) in 1996%-2003% to 66.2% (559/857) in 2011-2016 (P < 0.0001). Combination neonatal prophylaxis use significantly (P < 0.0001) increased over time, reaching 6.3% (56/857) after 2010, and it was largely (4.2%) adopted in early preterm infants. The proportion of vaginal deliveries in women with undetectable viral load (VL) increased over time and was 9.9% (85/857) in 2011-2016; no infection occurred among them. In children followed up since birth MTCT, rate was 3.5% (96/2783) in 1996-2003; 1.4% (36/2480) in 2004-2010; and 1.1% (9/835) in 2011-2016. At a multivariate analysis, factors associated with MTCT were vaginal delivery with detectable or missing VL or nonelective caesarean delivery, prematurity, breastfeeding, lack of maternal or neonatal antiretroviral therapy, detectable maternal VL, and age at first observation. Previously described increased risk of offspring of immigrant women was not confirmed. CONCLUSIONS: Risk of MTCT in Italy is ongoing, even in recent years, underling the need for implementation of the current screening program in pregnancy. Large combination neonatal prophylaxis use in preterm infants was observed, even if data on safety and efficacy in prematures are poor.