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Fetal-Maternal Surgery for Spina Bifida in a HIV-Infected Mother.

Authors :: Elrod J
Ochsenbein-Kölble N
Mazzone L
Zimmermann R
Berger C
Speck RF
Strübing N
Mohr C
Moehrlen U
Meuli M
Source :: Fetal diagnosis and therapy [Fetal Diagn Ther] 2022; Vol. 49 (1-2), pp. 25-28. Date of Electronic Publication: 2022 Jan 06.
Publication Year :: 2022
Abstract: Introduction: In select cases, in utero surgery for myelomeningocele (MMC) leads to better outcomes than postnatal repair. However, maternal HIV infection constitutes a formal exclusion criterion due to the potential of vertical HIV transmission. Encouraged by a previous case of a successful fetal spina bifida repair in a Hepatitis Bs antigen-positive woman, a plan was devised allowing for fetal surgery.<br />Case Report: In utero MMC repair was performed although the mother was HIV-infected. To minimize the risk of in utero HIV transmission, the mother was treated by highly active antiretroviral therapy throughout gestation as well as intravenous zi-dovudine administration during maternal-fetal surgery. The mother tolerated all procedures very well without any sequelae. The currently 20 month-old toddler is HIV negative and has significantly benefitted from fetal surgery.<br />Discussion/conclusion: This case shows that maternal HIV is not a priori a diagnosis that excludes fetal surgery. Rather, it might be a surrogate for moving towards personalized medicine and away from applying too rigorous exclusion criteria in the selection of candidates for maternal-fetal surgery.<br /> (© 2022 The Author(s). Published by S. Karger AG, Basel.)