"The latest report from the WHO shows that with 1.3 million (between 970,000 and 1.6
million) HIV-positive pregnant women worldwide in 2020, HIV continues to be a major
global public health issue. In France, approximately 2 out of 1,000 pregnant women are
infected with HIV, resulting in about 1,500 births per year over the past fifteen years.
Although therapeutic advances have not yet led to a cure for the infection, they have
increased life expectancy, improved the quality of life for people living with HIV, and
reduced mother-to-child transmission during pregnancy, childbirth, and breastfeeding.
Indeed, the very low transmission rate during replication has been completely eliminated.
The measurement of quality of life is increasingly used to complement the clinical or
biological management of a disease, as it provides data to evaluate the quality of
patient care, identify additional care needs, and assess the effectiveness of
interventions. This approach enhances patient experience and satisfaction with treatment,
in contrast to traditional management, which focuses on disease progression.
Generally, pregnant women report a lower health-related quality of life due to the impact
of pregnancy on their physiological and mental health. In addition to limited physical
activities in early pregnancy, most pregnant women are likely to experience nausea,
vomiting, dizziness, depression, nervousness, and anxiety throughout their pregnancy.
Compared to HIV-negative pregnant women, HIV-positive pregnant women may also have poorer
physical health, a greater susceptibility to depression, and worse mental health. Factors
such as education level, number of children, pregnancy symptoms, and occupation are key
determinants of Health-Related Quality of Life (HRQoL) for pregnant women.
Consequently, improving patient care by assessing HRQoL in HIV-positive pregnant women is
crucial for informing decision-making, resource allocation, and health policy
formulation.
Through this project, we will explore the HRQoL of women living with HIV during the
perinatal period under the care of the Infectious diseases department at Bichat-Claude
Bernard Hospital, PARIS, FRANCE.
In 2022, the Infectious diseases department of Bichat-Claude Bernard Hospital cared for
5,242 people living with HIV, including 544 women of childbearing age (under 43 years).
From January 1, 2005, to December 31, 2022, 1,158 women living with HIV were monitored
for pregnancy, with 1,036 delivering at Bichat-Claude Bernard Maternity.
During the period from January 1 to December 31, 2022, 43 women living with HIV were
followed at Bichat Maternity during their pregnancy, and 38 gave birth to live infants at
the hospital. Among these 38 women, the median age was 36 years (range: 20-50), and 86.8%
were originally from Sub-Saharan Africa.
According to the report from the Interministerial Mission on Poverty and Social
Exclusion, areas with the highest prevalence of poverty and social exclusion are located
in the northern part of Paris and Île-de-France, and the Bichat-Claude Bernard hospital
group is at the heart of this area. The PréCARE cohort study (which monitored pregnant
women from October 2010 to May 2012) highlighted specific vulnerabilities in this
territory, particularly among undocumented migrants who faced a higher risk of obstetric
complications compared to women born in France.
The outpatient follow-up for pregnant women living with HIV has been designed to provide
comprehensive health management during pregnancy, focusing not only on complications
related to the infection or pregnancy but also on ensuring ""a state of complete
physical, mental, and social well-being"" (WHO definition of health).
This approach ensures:
Adherence to and good tolerance of antiretroviral therapy, as well as effective
virological control of HIV infection
Proper management of pregnancy
Physical and psychological well-being
Addressing potential social issues."
