Three decades of perinatal HIV management in the Canary Islands, Spain

Perinatal transmission (PT) of human immunodeficiency virus (HIV) has decreased drastically in developed countries, but it still occurs with an incidence of around 1-2%. Our objective was to assess the PT of HIV in the Canary Island, Spain. We conducted a multicenter retrospective study from 1993 to 2021 involving pregnant women with HIV and their children attended in Las Palmas. Data on pregnancy, delivery, treatment, and outcomes were collected and divided into three periods: period 1 (P1) 1993-2003, period 2 (P2) 2004-2012, and period 3 (P3) 2013-2021. A total of 259 mother-child pairs were included. PT of HIV decreased over time (10.8% in P1, 2.2% in P2, and 1.1% in P3, p = 0.009). No cases of PT occurred among women on combined antiretroviral therapy (ART) before conception with undetectable viral load at delivery. In P1, most women were Spanish (83.2%). In P3, 60.4% were of foreign origin (26.7% from Africa, 24.4% from Latin America), and they showed lower CD4 lymphocyte counts. In P2 and P3, significantly more women started ART before pregnancy (20.5% in P1, 43.8% in P2, and 59.5% in P3, p = 0.008), and most women reached delivery with undetectable viral load (50% in P1, 70.4% in P2, 81.7% in P3, p < 0.001).

PT rates decreased significantly in Las Palmas, consistent with national and European trends. The management of HIV-infected pregnant women and their children improved over time, despite a higher proportion of mothers with worse immune status. However, there are still areas for improvement in early diagnosis and follow-up.

• Perinatal HIV transmission has decreased worldwide in the last 20 years due to effective prevention strategies.

• This study provides the first long-term analysis of perinatal HIV transmission in the Canary Islands (Spain), offering a detail overview of regional data.