A descriptive study of patients at high risk for mother-to-child transmission (MTCT) of HIV at Tygerberg Hospital: a retrospective review

Thesis (MMed)--Stellenbosch University, 2016.ENGLISH ABSTRACT: AIM This is a sub study of a main study with the primary aim of early identification of infants at high risk for HIV transmission, starting them on ARVs to prevent seroconversion and also possibly reverse early seroconversion. A secondary aim of the main study and our main focus is to identify the characteristics of mothers who are at a high risk of transmitting their HIV infection to their infants in the antepartum and intrapartum period. METHODS This was a retrospective study conducted at Tygerberg Hospital (TBH). A review of files spanning a 21 month period from the period 1 January 2011 till 30 September 2012 was performed. The selection criteria included pregnant HIV patients who were: exposed to AZT monotherapy for PMTCT for 4 weeks or less, exposed to combination ART for 4 weeks or less without preceding AZT monotherapy, with a measured plasma HIV viral load of ≥1000 copies/ml ≤8 weeks before birth, defaulted ART during pregnancy, first presented as HIV-seropositive at delivery or early in the postpartum period and delivered before 37 weeks gestational age. RESULTS During the study period a total number of 301 patients and their children were included in the study. These patients all came from a low to middle income resource setting. The mean age at delivery was 26.9 years. The median gravidity and parity was 3 and 1 respectively. The median gestational age at initiating antenatal care was 26 weeks. The mean gestational age at booking was 24.8 weeks. 35 patients were on ARVs during pregnancy. Of the remaining 266 patients: 143 patients were started on AZT prophylaxis during pregnancy, and 123 patients were never initiated on AZT prophylaxis. The mean gestation of AZT initiation was 27 weeks. A total of 108 patients never initiated any antenatal care at all. A total of 7 patients presented with antepartum haemorrhage and 21 mothers were grouped as having infections during pregnancy. The total number of deliveries was 301. 49.5% of all the deliveries were normal vertex deliveries. A total of 187 patients received AZT in labour. 115 patients received no AZT prophylaxis at all. More than half of the patients (188) in the study were seen with either medical complications or pregnancy related complications. 114 patients (37.8%) had hypertensive disease in pregnancy. 224 patients (74%) were diagnosed with HIV during the index pregnancy and 3.1% were diagnosed with HIV during labour. CONCLUSION It is clear that patients who do not initiate antenatal care have an increased risk of transmission in a population with an increased prevalence of HIV disease. Additional factors are the lack of initiation of ARV drugs at antenatal clinics and preterm labour and preterm deliveries.AFRIKAANS OPSOMMING: DOELWIT Dit is 'n substudie van 'n hoof studie met primêre doel die vroeë identifisering van babas met ‘n hoë risiko van MIV transmissie, om hulle te begin op ARV middels om serokonversie te voorkom en moontlik ook serokonversie om te keer. 'n Sekondêre doel van die hoof studie en ons hoof doel is om die eienskappe van moeders, wat hoë risiko is vir die oordrag van hul MIV-infeksie aan hul babas in die antepartum en intrapartumperiode, te identifiseer. METODES Dit was 'n retrospektiewe studie wat by Tygerberg-hospitaal (TBH) uitgevoer was. 'n Oudit van lêers, wat strek oor 'n tydperk van 21 maande vanaf 1 Januarie 2011 tot 30 September 2012, is uitgevoer. Die seleksie kriteria het die volgende swanger MIV pasiënte ingesluit: pasiënte blootgestel aan AZT monoterapie vir PMTCT vir 4 weke of minder, pasiënte blootgestel aan ‘n kombinasie ART vir 4 weke of minder sonder voorafgaande AZT monoterapie, pasiënte met 'n plasma MIV virale lading van ≥1000 kopieë / ml ≤ 8 weke voor geboorte, onderbroke ART tydens swangerskap, pasiënte wat vir die eerste keer as MIV-sero positief gediagnoseer is tydens hulle verlossing of vroeg in die postpartum periode, pasiënte wat voor 37 weke gestasie duurte verlos het. RESULTATE Gedurende die studie tydperk is ‘n totaal van 301 pasiënte en hul babas ingesluit in die studie. Hierdie pasiënte het almal van 'n lae tot middel inkomste omgewing gekom. Die gemiddelde ouderdom met verlossing was 26.9 jaar. Die mediaan graviditeit en pariteit was onderskeidelik 3 en 1. Die mediaan gestasie duurte om voorgeboortesorg te inisieer was 26 weke. Die gemiddelde gestasie duurte by die bespreking was 24.8 weke. 35 pasiënte was op ARV middels tydens swangerskap. Van die oorblywende 266 pasiënte: is 143 pasiënte begin op AZT profilakse tydens swangerskap, en 123 pasiënte is nooit geïnisieer op AZT profilakse nie. Die gemiddelde swangerskapsduurte van AZT inisiasie was 27 weke. 'n Totaal van 108 pasiënte het nooit enige voorgeboortelike sorg ontvang nie. 'n Totaal van 7 pasiënte het presenteer met antepartum bloeding en 21 pasiënte het infeksies tydens swangerskap gehad. Die totale aantal verlossings was 301. Byna 49.5% van al die verlossings was normale skedel geboortes. 'n Totaal van 187 pasiënte het AZT ontvang tydens kraam. 115 pasiënte het geen AZT profilakse ontvang nie. 114 pasiënte (37.8%) het hipertensiewe siekte tydens swangerskap gehad. 224 pasiënte (74%) is gedurende die indeks swangerskap gediagnoseer met MIV en 3,1% was tydens kraam gediagnoseer. GEVOLGTREKKING Dit is duidelik dat pasiënte wat nie voorgeboortesorg inisieër nie 'n verhoogde risiko het van MIV oordrag in 'n bevolking met 'n verhoogde voorkoms van MIV-siekte. Bykomstige faktore is gebrekkige inisieëring van ARV middels by voorgeboorte klinieke en voortydse kraam of voortydse verlossing.Master