Pregnancy in HIV vertically infected adolescents and young women: a new generation of HIV-exposed infants.

Vertically infected individuals are reaching childbearing age and the new generation of HIV-exposed infants is coming to pediatric care. The authors conducted chart reviews of 15 pregnancies among HIV vertically infected adolescents and young women. Girls were diagnosed with HIV at median age of 10.1 years (range 1.3-20). They started sexual life at a median age of 15 years (range 13-19); median age at pregnancy was 16.9 years (range 14-21.5). Slightly more than 36% had presented an AIDS-defining clinical event have been followed for median 8.5 years (range 2.9-15.8) and had used median two antiretroviral regimens (range 0-7). Fourteen (93.3%) received antiretroviral drugs during pregnancy; median CD4 cell count during pregnancy was 394 (range 117-651) cells/mul and median viral load was 4800 copies/ml (range 50-100 000); 54% had undetectable viral load near delivery. All patients delivered their babies by elective c-section. Median birth weight was 2650 g (range 2085-3595) median length was 47.3 cm (range 42-51) and median gestational age 38 weeks (range 37-39). All newborn received zidovudine for 6 weeks and none was breastfed. Fourteen (93%) infants were considered HIV-uninfected; one was lost to follow-up. The authors concluded that this group of adolescents seems to have sexual behavior similar to that of HIV-uninfected youth. Since this is an experimented antiretroviral population new drugs may be necessary for adequate viral suppression to avoid mother-to-child transmission of HIV. Follow-up of this third generation of HIV-exposed infants needs to be addressed within HIV adolescent care.