Mode of delivery in HIV-infected women in France between 2005 and 2009

Background: Since 2002, French guidelines for prevention of mother-to-child transmission of HIV have recommended vaginal delivery in case of maternal viral load near delivery < 400 cp/mL and planned caesarean section (CS) in case of viral load >400 cp/mL. We aimed to describe frequency of, and factors associated with mode of delivery.
Methods: All pregnancies of HIV1-infected women enrolled between 2005 and 2009 in the detailed component of the national French Perinatal Cohort (ANRS-CO1-EPF) were categorized into two groups according to maternal viral load near delivery: uncontrolled (>400copies/mL: N=254) and controlled (< 400copies/mL: N=2548).
Results: For women with uncontrolled viral load, the main mode of delivery was planned CS as recommended (49.6%). Nevertheless 24.8% of women delivered vaginally, much more frequently in premature than term deliveries (82.8% vs 18.4%, p< 0.01).
For women with controlled viral load, 48.0% delivered vaginally and 30.6% had a planned CS. In that group, vaginal delivery was associated with Sub-Saharan Africa origin, multiparity, characteristics of maternity and indicators of optimal follow up (HIV diagnosed before the last gestational trimester, undetectable VL < 50cp/ml near delivery). Previous caesarean was mentioned as only or associated indication for 41.9% of the planned CS with well controlled viral load. Other obstetrical or maternal indication in lack of repeat caesarean concerned 23.8% of them. HIV infection was the only indication reported for 18%.
Prolonged hospitalization and maternal post-partum complications were more frequent in case of caesarean than vaginal delivery (p< 0.01), with a higher proportion of prolonged hospitalisation in case of uncontrolled viral load.
Conclusion: Among women with VL >400 cp/mL, one quarter delivered vaginally, but, overall, this situation was very rare: only 2.2% of all women included. Planned CS was performed in one third of women with well controlled VL near delivery, including 18% with no other indication than HIV infection.

C. Jasseron1,2, J. Pollet3, Y. Hammou3, J. Sibiude4, L. Assoul4, N. Bouallag4, R. Tubiana5, J. Warszawski2,4,6, L. Mandelbrot4,7,8, The ANRS French Perinatal Cohort
1CESP, INSERM U1018, HIV Epidemiology, Le Kremlin Bicêtre, France, 2Hopital Bicêtre, Epidemiology and Public Health Service, Le Kremlin Bicêtre, France, 3CHRU de Lille, Lille, France, 4CESP, INSERM U1018, Le Kremlin Bicêtre, France, 5Hopital Pitié-Salpetriére, Department of Infectious Diseases,, Paris, France, 6Université Paris-Sud, Le Kremlin Bicêtre, France, 7Hopital Louis Mourier, Service de Gynecologie-Obsétrique, Colombes, France, 8Université Paris Diderot - Paris 7, Paris, France