Rubella susceptibility profile in pregnant women with HIV

Data on susceptibility, assessed through serological testing or personal history, were analyzed with respect to several demographic and HIV-related characteristics. Following exclusion of 93 women with rubella status reported as unknown, 1146 pregnancies with a live birth were analyzed. Overall, between 2001 and 2009, 303 women (26.4%) were reported as susceptible. Among the 843 nonsusceptible women, 163 (19.3%) were reported as previously vaccinated, with a significant increase during the study period in the proportion of vaccinated women, from 3.4% in 2001 to 25.0% in 2009 (χ2 for trend: P  <  .001). During the same period, the proportion of susceptible women decreased significantly, from 26.9% in 2001 (36.2% in 2002) to 18.8% in 2009 (P  =  .002). The general characteristics of susceptible and nonsusceptible women are reported in Table 1. Rubella susceptibility was not associated with any particular HIV-related or demographic characteristic, but appeared to be significantly associated with susceptibility to Toxoplasma infection (odds ratio [OR]: 3.10, 95% confidence interval [CI]: 2.24–4.29, P  <  .001) and with susceptibility to cytomegalovirus (CMV) infection (OR, 6.90; 95% CI, 5.06–9.14; P  <  .001), with a borderline-significance association (P  =  .063) with a negative history of sexually transmitted infections [STI] (OR, 1.49; 95% CI, .98–2.29). View this table: In this windowIn a new windowTable 1. Characteristics Of Pregnant Women With and Without Rubella Susceptibility Overall, among 1011 children with available information on birth defects, no cases of CRS were observed. The overall birth defect rate (3.4%; 95% CI, 2.3–4.5) was similar to other studies on HIV infection [4, 5]. Only 2 women (.19%) were positive for rubella IgM antibodies during pregnancy (at 16 and 30 wk of pregnancies, respectively). In both cases, children had no birth defects or functional abnormalities. In our cohort, which collects, based on HIV seroprevalence data [6], no less than 40% of deliveries in HIV-infected women in Italy, about 20% of HIV-infected pregnant women appear to be currently susceptible to rubella infection. This proportion is high compared with other studies on rubella seroprevalence in Italy [7] and suggests higher susceptibility rate and lower frequency of vaccination among women with HIV. It is unknown to what extent concerns about using a live attenuated vaccine in women with HIV may be responsible for the low frequency of vaccination observed. However, in our sample, only a limited proportion of women had low CD4 count or clinically relevant immunosuppression that may have prevented vaccination. The significant reduction in the rate of susceptibility during the last decade, coupled with the concurrent significant increase in the proportion of vaccinated women, is encouraging and suggests that a further decline in rubella susceptibility can be obtained in this population using appropriate vaccination strategies. Our data also suggest that susceptibility to rubella is associated to susceptibility to other infections that may be responsible for congenital syndromes or newborn infections (Toxoplasma, CMV, or sexually transmitted infection), and as such reinforce the need for an appropriate preconception counseling and care in this particular population. Next SectionAcknowledgments The Italian Group on Surveillance on Antiretroviral Treatment in Pregnancy Project coordinators: M. Floridia, M. Ravizza, E. Tamburrini. Investigators: M. Ravizza, E. Tamburrini, F. Mori, P. Ortolani, E.R. dalle Nogare, G. Sterrantino, M. Meli, S. Polemi, J. Nocentini, M. Baldini, G. Montorzi, M. Mazzetti, B. Borchi, F. Vichi, E. Pinter, E. Anzalone, R. Marocco, C. Mastroianni, V.S. Mercurio, A. Carocci, E. Grilli, A. Maccabruni, B. Mariani, A. Moretti, G. Natalini, G. Guaraldi, K. Luzi, G. Nardini, C. Stentarelli, A. Degli Antoni, A. Molinari, P. Rogasi, M.P. Crisalli, A. Donis