Characteristics of HIV-Infected Women Who Do Not Receive Preventive Antiretroviral Therapy in the French Perinatal Cohort

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Abstract
To determine the percentage and the profile of women with known HIV-1 seropositivity who do not receive the prepartum phase of preventive treatment for maternofetal transmission. An observational study was conducted as part of the French Perinatal Cohort, an ongoing nationwide cohort of HIVinfected women and their children (followed from birth). This analysis was restricted to women who were delivered between 1996 and 1999. Among the 2167 women studied, 92 (4.3%) did not receive the prepartum phase of preventive treatment. This proportion fell below 10% in 1996 and subsequently stabilized at 3% to 4%. The reasons for nontreatment were the woman's refusal (34%), premature delivery (8%, before initiation of planned treatment), late diagnosis of maternal HIV infection (3%, at the time of delivery), or unmonitored pregnancy (54%). One third of the women in this latter category were aware of their seropositivity before becoming pregnant. Treated and untreated women did not differ in terms of the usual parameters of HIV infection, geographic origin (sub-Saharan Africa vs. Europe), or HIV transmission category (sexual vs. intravenous [IV] drug use). Untreated women were also less likely than treated women to receive other preventive measures such as intrapartum IV zidovudine infusion, treatment of the newborn, and formula feeding. Indirect evidence strongly suggested that the untreated women were socially marginalized. The prepartum phase of preventive treatment for maternofetal transmission is well accepted by HIV-seropositive women in France. The proportion of women who do not receive this treatment could be further reduced by earlier screening (before or at the beginning of pregnancy) and by focusing on a small subgroup of socially marginalized women.