The AmRo study: pregnancy outcome in HIV-1-infected women under effective highly active antiretroviral therapy and a policy of vaginal delivery

BJOG. 2007 Feb;114(2):148-55. doi: 10.1111/j.1471-0528.2006.01183.x.


Objective: To explore pregnancy outcome in HIV-1-positive and HIV-negative women, and mother-to-child transmission (MTCT) according to mode of delivery under effective highly active antiretroviral therapy (HAART).

Design: Cohort of 143 pregnant HIV-1-infected women including a matched case-control study in a 2:1 ratio of controls to cases (n=98).

Setting: Academic Medical Center in Amsterdam and Erasmus Medical Center in Rotterdam, the Netherlands.

Population: Consecutive referred HIV-1 infected pregnant women treated with HAART and matched control not infected pregnant women.

Main outcome measures: MTCT, preterm delivery, low birthweight, pre-eclampsia.

Results: MTCT was 0% (95% CI 0-2.1%). Seventy-eight percent of HIV-1-infected women commenced and 62% completed vaginal delivery. The calculated number of caesarean sections needed to prevent a single MTCT was 131 or more. Preterm delivery rates were 18% (95% CI 11-27) in women infected with HIV-1 and 9% (95% CI 5-13) in controls (P=0.03). HAART used at <13 weeks of gestation was associated with a 44% preterm delivery rate compared with 21% when HAART was started at or after 13 weeks and 14% in controls. (Very) low birthweight and incidence of pre-eclampsia were not different between HIV-1 and controls.

Conclusions: We have not demonstrated any MTCT after vaginal delivery in women effectively treated by HAART. The HAART-associated increase in preterm delivery rate is mainly seen after first trimester HAART use.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Antiretroviral Therapy, Highly Active*
  • Birth Weight
  • Case-Control Studies
  • Cohort Studies
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / transmission
  • HIV-1*
  • Humans
  • Infectious Disease Transmission, Vertical
  • Obstetric Labor, Premature / etiology
  • Pre-Eclampsia / etiology
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Pregnancy Outcome*
  • Regression Analysis
  • Risk Factors
  • Viral Load