Is "option B+" also being adopted in pregnant women in high-income countries? Temporal trends from a national study in Italy.

The World Health Organization currently recommends lifelong continuation of antiretroviral therapy (ART) after delivery (“Option B+”) as an option for human immunodeficiency virus (HIV)-infected women starting combination ART in pregnancy [1]. This approach is therefore increasingly being implemented in African countries with high HIV disease burden [2–4] and evaluated in economic studies [5, 6]. The advantages of this strategy include ease of implementation, no need for CD4 and HIV RNA testing, possibility to initiate immediately treatment, potential better retention in care, and reduced risk of sexual HIV transmission to uninfected male partners [7]. It is not known to which extent a similar approach is being adopted in high-income countries, where, despite a lower HIV disease burden and fewer economic constraints, some of the benefits may be the same. To explore this issue, we used data from the Italian National Program on Surveillance on Antiretroviral Treatment in Pregnancy [8], a national observational study of pregnant women with HIV established in 2001, where therapeutic decisions are taken by the individual physicians. We considered all pregnancies ending in live births among antiretroviral-naive women with no indication to ART for their own health (defined …