Asymptomatic women at high risk of vertical HIV-1 transmission to their fetuses.
OBJECTIVE
To identify how reliably CD4+ (helper) lymphocyte count and p24 antigenaemia can predict mother-to-infant transmission of human immunodeficiency virus type 1 (HIV-1).


METHODS
Prospective study.


METHODS
University of Turin Center for Intravenous Drug Users (IVDU) and/or HIV-1 seropositive pregnant women.


METHODS
Twenty-nine infants born to asymptomatic seropositive women from November 1985 to June 1991.


RESULTS
Seven children (24%) developed symptomatic infection, while 22 healthy seronegative children at the age of 18 months were considered uninfected. A CD4+ lymphocyte count persistently < 500/mm3 during pregnancy was associated significantly with the child's infection status with a relative risk (RR) of 11.4. (CI 1.58-82.05). A marked association (RR 13.6) (CI 1.93-95.72) was similarly detected between maternal antigenaemia and the risk of the child being infected. In a multivariate logistic analysis, crude and adjusted odds ratios (OR) of transmission were 27.0 (95% CI 2.5-291.2) and 35.6 (1.1-1159) for low CD4+ counts; 64 (3.2-1261) and 51.6 (2.5-1058) for p24 antigenaemia.


CONCLUSIONS
Asymptomatic HIV positive women with a CD4+ count below 500/mm3 or p24 antigenaemia are about ten times as likely to transmit the virus to their children. CD4+ lymphocytes decrease during pregnancy and a low CD4+ cell count early in pregnancy remains low up to delivery. Therefore knowledge that they have a low CD4+ lymphocyte count early in pregnancy may help women to decide whether or not to continue their pregnancy.
Tibaldi
C
C
Istituto di Ginecologia e Ostetricia, Università di Torino, Italy.
Tovo
P A
PA
Ziarati
N
N
Palomba
E
E
Salassa
B
B
Sciandra
M
M
D'Ambrosio
R
R
Ponti
A
A
Sinicco
A
A
D000328:Adult; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D005260:Female; D005315:Fetal Diseases / Q000209:etiology; D016655:HIV Core Protein p24 / Q000276:immunology*; D006679:HIV Seropositivity / Q000276:immunology / Q000635:transmission*; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D007958:Leukocyte Count; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015819:Substance Abuse, Intravenous
D016655:HIV Core Protein p24