Pregnancies Among the First Generation of Survivors of Perinatal HIV Infection

J Obstet Gynaecol Can. 2020 Apr;42(4):446-452. doi: 10.1016/j.jogc.2019.09.022. Epub 2019 Dec 25.


Objective: Little is known about pregnancy outcomes among women who have acquired human immunodeficiency virus (HIV) through perinatal infection and survived into adulthood. The objectives of this study were to describe pregnancy outcomes among women with perinatal HIV infection (PHIV) in Canada and to identify potential challenges in the prevention of perinatal HIV transmission in this population.

Methods: A retrospective review of all pregnancies among women with PHIV who were previously followed as children at two tertiary care centres in Montréal, Québec, was conducted. Data were extracted from pediatric and obstetrical records.

Results: There were 21 pregnancies among 11 women, and 18 of these pregnancies were unintentional. Mean age at first pregnancy was 19.5 years (range 15-29 years). At the first prenatal visit, 79% had a detectable viral load, 36% were immunosuppressed (CD4 T cell count <200 mm3), and only 36% were receiving antiretroviral therapy (ART). At the time of delivery, although all were prescribed ART, 50% of these women still had a detectable viral load, and 36% remained immunosuppressed. All of the women harboured mutations conferring drug resistance to zidovudine and lamivudine, and the majority (73%) were also resistant to nevirapine. None of the infants were HIV infected, although all received prophylaxis with agents to which their mother's virus was resistant.

Conclusion: Unplanned pregnancies, difficulties with adherence to ART, and drug resistance were identified challenges in the management of pregnancies among women with PHIV. This study highlights a gap in the reproductive counselling of adolescents with PHIV and the need for close follow-up and adherence support during pregnancy in this population.

Keywords: HIV; infectious disease transmission, vertical; long-term survivors; outcome; pregnancy; reproductive health.

MeSH terms

  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active / methods*
  • Canada / epidemiology
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / transmission
  • HIV Long-Term Survivors / psychology*
  • HIV Long-Term Survivors / statistics & numerical data
  • Humans
  • Infant
  • Infectious Disease Transmission, Vertical / prevention & control
  • Medication Adherence / psychology
  • Pregnancy
  • Pregnancy Complications, Infectious / drug therapy*
  • Pregnancy Complications, Infectious / epidemiology
  • Pregnancy, Unplanned*
  • Quebec / epidemiology
  • Retrospective Studies
  • Viral Load
  • Young Adult
  • Zidovudine / therapeutic use


  • Anti-HIV Agents
  • Zidovudine