HIV-1 infected women in Europe A thesis presented for the degree of Doctor of Philosophy University of London

This thesis aims to describe the wider impact of HIV infection on reproductive choices and pregnancy outcomes in HIV-infected women in Europe. Characteristics of 403 HIV-infected women enrolled in a survey on reproductive choices are described. There was no evidence to suggest HIV-infected women have problems to conceive; maternal well-being, an uninfected partner and not having children yet were strongly associated with being pregnant. Results from a laboratory-based descriptive study, including 57 pregnant women provide a biological explanation for HAART-associated premature delivery in HIVinfected women; cytokine patterns (IL2 and IL10) were analysed over three trimesters of pregnancy and in relation to gestational age at delivery. Intrauterine growth (femur length, head and abdominal circumference) of infants born to 316 HIV infected mothers, compared to an uninfected population is reported. The average z-score of head circumference and femur length in HIVinfected women was below the reference (32th centile and 15th centile respectively), but the average z-score for abdominal circumference differs only marginally (49th centile). In order to add one more piece of information in relation to maternal treatment and gestational age at delivery, birth-weight from a large European cohort was analysed and compared to the British standard. Mean z-scores decreased from 0.10 (46th centile), -0.13 (45th centile) and -0.30 (37th centile) throughout gestation indicating that children born to HIV infected mothers became smaller towards the end of pregnancy, and premature delivery in HAART-treated mothers was not associated to fetal distress. Complications after delivery according to infection status of the mother and mode of delivery, were reported from a total of 250 HIV-status matched pairs delivered vaginally and from 158 by elective caesarean section. HIV-infected women suffered an increased risk of minor complications, but major complications only occurred in the caesarean section arm.