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WHO recently recommended efavirenz (EFV) use for HIV infection through pregnancy, breastfeeding and childbearing age. However the use of EFV during pregnancy remains of concern and not all national guidelines reflect WHO advice. Few data are available concerning pregnancy outcomes. The objective of our study was to evaluate pregnancy outcomes in a cohort of women who conceived on EFV. A retrospective, multicenter cohort study was conducted in Pointe Noire, Republic of Congo (September 2005- June 2012). The following adverse pregnancy outcomes were considered: births defects, low birth weight, premature delivery, stillbirth and abortion, stratified by antiretroviral exposure at the time of conception. During the study period, 188 women conceived on antiretrovirals: 35 (18.6%) on EFV-based regimens and 153 (81.4%) on nevirapine-based regimens. Adverse pregnancy outcomes were observed in 17/35 (48.6%, 95% CI 33.0-64.4%) women in the EFV group and in 43/153 (28.1%, 95% CI 21.6-35.7%) in the non-EFV group (p=0.019). No birth defect was observed in either group. An increased incidence of adverse pregnancy outcomes was observed in the EFV group. As WHO is promoting a widespread use of EFV also for women in childbearing age, our study emphasizes the importance of launching large prospective cohort studies investigating pregnancy outcomes in exposed women.

Several outbreaks of measles have been reported since 2007 both in Italy and elsewhere in Europe. The objective of this study was to analyze the characteristics of the cases of measles that were hospitalized at San Martino Hospital from January 2008 to April 2009. All suspected cases of measles from January 2008 to April 2009 were analyzed. Laboratory confirmation was attained by determination of measles-specific IgM antibodies with enzyme immunoassay and/or detection of the measles virus genome in throat swab or urine by nested polymerase chain reaction (PCR). In all, 114 patients with clinically suspected measles were observed and laboratory confirmation was obtained in 83 cases: 34 (34/83; 41%) by specific genome PCR; five (5/83; 6%) only by IgM antibodies and 44 (44/83; 53%) by both methods. The median age was 25 years (range 15-66). The vaccination status was known for 80/83 patients, amongst whom the proportion of unvaccinated was 90% (72/80). No severe complications were observed. The most common complications were nausea/vomiting in 28/83 (34%) and radiologically documented interstitial pneumonia in 22/83 (26%) cases. The median length of hospitalization was five days (range 1-9 days). Almost 90% of patients were aged 20 years and older and hence measles cannot be regarded solely as a childhood disease. Thus widespread high vaccination coverage would be required to prevent new outbreaks and hospitalizations in the adult population.