Obstetric Management and Outcomes for Women Living With HIV in Western Australia: A 30 Year Review

In 1991 a statewide service for the management of pregnant women living with HIV (WLHIV) was established in Western Australia (WA).

To review the maternal epidemiology and obstetric and neonatal outcomes for pregnancies in WLHIV under the care of this multidisciplinary management team since its inception.

All ongoing pregnancies for WLHIV between 1991 and December 2022 were identified from interrogation of the state-wide multidisciplinary perinatal HIV management database. WLHIV with early pregnancy losses or who delivered outside of WA were excluded.

Two hundred and thirty four viable pregnancies to 162 WLHIV occurred. Maternal ethnicity altered significantly; the rate of new cases of pregnancies in WLHIV for African and Southeast Asian women being 3.92 times (95% CI 1.22-12.60, p = 0.022) and 4.41 times higher (95% CI 1.37-14.25, p = 0.013) from 2007 to 2022, respectively, from those in 1998 to 2006. A significant decrease in HIV-exposed pregnancies occurred among Indigenous Australian women during these time periods (IRR 0.15, 95% CI 0.05 to 0.44, p = 0.001). Over time there was a significant reduction in the proportion of women with a detectable viral load at booking. Prior to 2007, 31 cases (72.1%) had a detectable viral load at booking compared with 68 (38.9%) from 2007 onwards (p < 0.001). Overall, an undetectable viral load at delivery was recorded for 88.3% (197/223). The vertical HIV transmission rate was very low, with one case (0.4%) reported. Most women formula fed their babies (94.5%).

A state-wide multi-disciplinary service, combined with universal antenatal HIV screening, has been successful in preventing HIV MTCT in WA.