Pregnancy in adolecents attending a paediatric HIV clinic in South Africa

Abstract

Background Pregnancy amongst adolescents with HIV acquired perinatally is a relatively new occurrence that will grow in frequency as this population matures. Aim This study describes the population of HIV infected adolescents in care at a paediatric HIV clinic who have had pregnancies, including the immunological and virological status on admission to the clinic. I describe the treatment exposure and response. To gain an alternative understanding of this population, an account of their lived experience is given. Methods A sequential mixed methods approach was used in which a database and record review was completed for all patients who had been pregnant while in care at the clinic (n=17). Thereafter, three individual semi-structured interviews were conducted with members of the study population and analysed using thematic analysis. Results Two subgroups within this population emerged: one with clear perinatal infection and one with high-risk exposure for horizontal transmission or an HIV negative mother. On admission to the clinic (mean age 10,9 years) the median CD4 count was 210 cells/μL (13%) with a median HIV VL was 4,2 log copies per ml. Forty-seven per cent (n=8) had AIDS defining criteria at presentation. All patients in the study achieved immune recovery and virological suppression during the course of treatment. Pregnancy outcomes included 16 live births, 5 terminations of pregnancy and one miscarriage. All but one infant were HIV uninfected at the 6 week HIV PCR test. There were high rates of psychiatric co-morbidity, sexual assault and psychosocial concerns within this population. Study participants were found to cope with their diagnoses well once disclosed to, though disclosure to their sexual partners is an area of concern as it is frequently delayed until after childbirth. The HIV education received does not adequately address the risks of onward HIV transmission to sexual partners, as well as the risk to the individual of HIV re-infection or acquiring other sexually transmitted infections. All participants perceived a need for support and guidance within the community, and wanted to serve their communities in health-related careers. One interview participant had planned her first pregnancy, insufficient data is available from records to determine whether other pregnancies were planned or not. Conclusion The risk of HIV transmission to offspring is low. Early disclosure of HIV status to adolescents as well as more comprehensive HIV education would serve to improve risk of HIV transmission at an individual level. These adolescents require support in identifying and safely managing the challenges associated with HIV infection. Their reproductive health needs must be addressed to facilitate a healthy and normal life into adulthood. At a community level effort is required to improve safety and poverty levels, which contribute to and exacerbate this entity of adolescent pregnancy in this population.