ABSTRACT Background and Aims Since the discovery of human immunodeficiency virus (HIV) mother to child transmission (MTCT), its prevention has been a priority. Guideline adherence has drastically reduced MTCT, virtually inexistent today in high‐income countries. Methods Our retrospective study included consecutive pregnant women with HIV who delivered in the Montpellier University Hospital between 2000 and 2020. We sought to examine our center's practices, outcomes, and illustrate the changes in management of pregnant women infected with HIV. Based on significant changes in French HIV guidelines and ART recommendations, we defined timelines for mode of conception, ART strategy, mode of delivery, and pediatric guidelines. These periods were compared to assess changes in our practice. χ 2 test, Fisher's exact test, Kruskal–Wallis H test, and Cochran–Armitage test were used when appropriate. Results We included 144 women and report a total of 194 pregnancies—of which 39 repeat pregnancies and 9 twin pregnancies—resulting in 201 live births. Between 2000 and 2020, 27 (13.9%) women discovered their HIV‐positive status during pregnancy. Over these 20 years, maternal antiretroviral therapy (ART) was started progressively earlier during pregnancy ( p < 0.01), planned ART interruptions became less frequent ( p < 0.01), and monotherapy was increasingly replaced by boosted triple therapy ( p < 0.01). Frequency of vaginal deliveries increased ( p < 0.01), and intrapartum intravenous Zidovudine was seldom used after 2013 ( p < 0.01). Approximately 98% of newborns received antiretroviral prophylaxis at discharge, and 91.3% of infants had at least 6 months of follow‐up. We observed only one case of MTCT in 2000. Conclusion Our study illustrates the major changes for the prevention of HIV MTCT. Our findings highlight how early and effective triple ART led to better obstetrical outcomes requiring fewer medical interventions. Thorough treatment, aligned with national guidelines, can virtually eliminate MTCT, serving as a model for global practice.
Dmitrenko et al. (Wed,) studied this question.