%0 Journal Article
%T Amniocentesis in HIV Pregnant Women: 16 Years of Experience
%A Mafalda Sim£¿es
%A Catarina Marques
%A Ana Gon£¿alves
%A Ana Paula Pereira
%A Joaquim Correia
%A Jo£¿o Castela
%A Cristina Guerreiro
%J Infectious Diseases in Obstetrics and Gynecology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/914272
%X The iatrogenic risk of HIV vertical transmission, calculated in initial epidemiologic studies, seemed to counterindicate invasive prenatal diagnosis (PND) procedures. The implementation of highly active antiretroviral therapy (HAART) represented a turning point in PND management, owing to a rapid and effective reduction of maternal viral load (VL). In the present study, we identified cases of vertical transmission in HIV-infected pregnant women who did amniocentesis in the second trimester of pregnancy ( ), from 1996 to 2011. We divided our sample into Group A¡ªwomen under HAART when submitted to amniocentesis ( ) and Group B¡ªwomen without antiretroviral therapy before amniocentesis ( ). We had 1 case of vertical transmission in Group B. Preconceptional or early first trimester HIV serology is essential to avoid performing an amniocentesis without antiretroviral therapy or viral suppression. When there is an indication for amniocentesis in an HIV-infected pregnant woman, it should be done if the patient is on HAART and, if possible, when VL is undetectable. Nowadays, with combined first trimester screening test to select pregnancies with high risk of aneuploidies, advanced maternal age is a less frequent indication to perform PND invasive procedures, representing an outstanding gain in prenatal diagnosis of this population. 1. Introduction The widespread use of highly active antiretroviral therapy (HAART) during the last decade has significantly reduced the rates of HIV mortality and disease progression [1]. The rate of vertical transmission in HIV-infected pregnant women on HAART is around 1-2%, being almost zero when associated with an elective cesarean delivery and avoidance of breastfeeding [2]. Simultaneously, there has been an increase in pregnancy rates among HIV-infected women, raising new problems and issues in prenatal diagnosis (PND), such as those concerning invasive procedures to diagnose chromosomal abnormalities (amniocentesis and chorionic villus sampling) [3]. The increase in the mean maternal age is a challenge in prenatal diagnosis, particularly in HIV-infected pregnant women. In the past, invasive procedures as amniocentesis were generally discouraged in HIV-infected pregnant women, due to increased risk of vertical transmission. The puncture of the uterine wall or placenta and lesions of the fetal skin or umbilical chord may all increase the fetal exposure to maternal virus [4]. Amniocentesis itself has potential morbidity, such as rupture of membranes, chorioamnionitis, or placental abruption, with consequent fetal loss or vertical
%U http://www.hindawi.com/journals/idog/2013/914272/