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Maria Barbara Alliegro, MD; Andrew N. Phillips, PhD; Stefano Boros, MD; Mauro Zaccarelli, MD; Raffaele Pristerà, MD; Giovanni Rezza, MD

Arch Intern Med. 1997;157(22):2585-2590.

Abstract
Background
The increasing incidence of human immunodeficiency virus (HIV) infection in women of childbearing age led us to evaluate whether pregnancy affects the natural history of this disease.

Objectives
To conduct a prospective study of women with known dates of HIV seroconversion to describe the incidence and outcome of pregnancy and to assess differences according to age and exposure group. To compare the rate of disease progression between pregnant and nonpregnant women.

Patients
All participants, recruited from 14 clinical centers in Italy, had documented HIV-seronegative test results followed by confirmed positive test results within 2 years.

Results
A total of 331 women, who had seroconversion between 1981 and 1994, were followed up for a median of 5.5 years from seroconversion; 94 developed HIV-related diseases, 47 developed acquired immunodeficiency syndrome, and 53 had at least 1 CD4 cell count lower than 0.10x 10⁹/L (<100 cells/mm³). Thirty-eight women (11.5%) were pregnant at the time of HIV seroconversion and 31 (9.4%) became pregnant after HIV seroconversion (cumulative incidence of pregnancy within 8 years of seroconversion, 28.9%; 95% confidence interval, 21.6%-36.2%). Forty-five (65.2%) of the 69 pregnancies were carried to term. There were no discernible differences in these findings by age or exposure group. Pregnant women did not experience a more rapid rate of progression of disease, even when adjusting for age, exposure group, CD4 cell count, or use of treatment (adjusted relative hazards: HIV-related diseases, 0.72; acquired immunodeficiency syndrome, 0.69; CD4 cell count <0.10x109/L, 1.24).

Conclusion
Women infected with HIV continue to become pregnant after seroconversion, yet pregnancy does not appear to influence the rate of progression of HIV disease.

Arch Intern Med. 1997;157:2585-2590

Author Affiliations
Maria Dorrucci, DStat; Patrizio Pezzotti, DStat; the Italian Seroconversion Study Group

From the Istituto Superiore di Sanità, Laboratory of Epidemiology and Biostatistics, Centro Operativo AIDS, Rome, Italy (Drs Alliegro, Dorrucci, Pezzotti, Boros, and Rezza), the Royal Free Hospital School of Medicine, Department of Public Health, London, England (Dr Phillips), the III Division of Infectious Diseases, Lazzaro Spallanzani Hospital, Rome (Dr Zaccarelli), and the Ospedale Regionale, Bolzano Hospital, Bolzano, Italy (Dr Pristerà). For a list of members of the Italian Seroconversion Study Group, see page 2589.

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