European Journal of Obstetrics & Gynecology and Reproductive Biology 91 (2000) 149–153 www.elsevier.com / locate / ejogrb Original Article The changing HIV epidemic in Italian pregnant women a, a a b c d e * S. Fiore , A.E. Semprini , M. Ravizza , A. Bucceri , M.L. Muggiasca , B. Guerra , A. Spinillo , a G. Pardi a Department of Obstetrics and Gynecology, Ospedale San Paolo, Milan, Italy b Department of Obstetrics and Gynecology, Clinica Mangiagalli, Milan, Italy c Department of Obstetrics and Gynecology, Ospedale Sacco, Milan, Italy d Department of Obstetrics and Gynecology, Policlinio san Orsola, Bologna, Italy e Department of Obstetrics and Gynecology, Policlinico San Matteo, Pavia, Italy Accepted 29 September 1999 Abstract Objective: To describe changes in the characteristics of HIV-pregnant women in Italy and the impact of strategies for prevention of HIV vertical transmission. Study design: Since 1985, HIV-infected women and their children are followed in 23 European centres in the European Collaborative Study (ECS), according to a standard protocol. Eight Italian Obstetric units participating in the ECS enrolled 815 patients. Results: Overall use of zidovudine to reduce HIV vertical transmission has increased significantly since 1994 and between 1995 and 1997, 57% of Italian women were treated. However, 27% of babies received the infant component of the 076 regimen. Over the years, age at delivery has increased and their CD4 count at delivery decreased, most likely reflecting heterosexually infected women with a longer duration of infection. The increasing rate of elective caesarean section (42%) is not related to maternal, foetal or obstetrical indications, but its use as an intervention to reduce HIV vertical transmission. Conclusions: The identification of HIV-infected women during pregnancy or before delivery ensures the appropriate management of the woman and her child, and clinicians should be aware of the increasing number of women with heterosexual acquisition of HIV-infection who may be less easily identified.  2000 Elsevier Science Ireland Ltd. All rights reserved. Keywords: HIV; Pregnancy; Italy 1. Introduction anti-retroviral treatment for HIV infection has led to a marked reduction of morbidity and mortality. Women account for an increasing proportion of reported In early 1994, results of the French–American random- AIDS cases in Europe [1]. In 1985 only 11% of adult ised trial (ACTG076) on zidovudine (ZDV) indicated that AIDS cases were in women, whereas in 1996 this had a regimen of antenatal, intrapartum and neonatal ZDV increased to 22%. Most of these were women of reproduc- therapy reduces the risk of vertical transmission by two- tive age. During the past ten years, antenatal care for thirds in a non-breastfeeding population [2]. Delivery by HIV-infected pregnant women has improved and targeted elective caesarean section has shown to be a nonphar- macological approach to reduce the risk of late HIV transmission during pregnancy [3–5]. With more evidence becoming available regarding factors relating to the risk of *Corresponding author. Present address: Department of Paediatric vertical transmission and possible interventions to reduce Epidemiology, Institute of Child Health, 30 Guilford Street, London this risk, clinicians are likely to change aspects of obstetric WC1N 1EH, UK. Tel.: 144-171-905 2105; fax: 144-171-813-8145. E-mail address: S.Fiore@ich.ucl.ac.uk (S. Fiore) practice for HIV-infected women. 0301-2115 / 00 / $ – see front matter  2000 Elsevier Science Ireland Ltd. All rights reserved. PII: S0301-2115(99)00268-7