Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic, and placental factors.
OBJECTIVE
To evaluate how maternal and obstetric factors interact to influence mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission.


METHODS
Prospective, observational cohort study of children born to HIV-infected women to determine child's HIV infection status. The analysis then compared peripartum maternal, placental, and obstetric variables between HIV-1 transmitter and nontransmitter women.


METHODS
Two large maternity wards in Kinshasa, Zaire.


METHODS
Consecutive sample of 324 HIV-1-infected women at delivery, with 254 HIV-seronegative women followed up as control subjects. PRINCIPAL OUTCOME MEASURES: HIV infection status of children, to classify each woman as an HIV-1 transmitter or nontransmitter.


RESULTS
The highest transmission risk (TR) was associated with maternal p24 antigenemia (TR, 71%; relative risk [RR], 3.0; 95% confidence interval [CI], 1.7 to 5.2) and maternal CD8+ lymphocyte counts of at least 1.80 x 10(9)/L (1800/microL) (TR, 50%; RR, 2.2; 95% CI, 1.2 to 4.2). Among women with CD8+ lymphocyte counts of less than 1.80 x 10(9)/L, CD4+ lymphocyte counts of less than 0.60 x 10(9)/L were a risk factor (TR, 29%; RR, 2.2; 95% CI, 1.2 to 4.2). In women with neither high CD8+ nor low CD4+ lymphocyte counts, placental membrane inflammation was associated with perinatal transmission (TR, 40%; RR, 4.2; 95% CI, 1.3 to 13.7). In women with neither p24 antigenemia, high CD8+ or low CD4+ lymphocyte counts, nor placental membrane inflammation, the transmission risk was only 7%. Additional correlates of transmission included maternal anemia and fever, but not maternal sexually transmitted diseases.


CONCLUSIONS
Identifiable subgroups of HIV-1-infected women based on maternal and placental characteristics had between a 7% and 71% risk of perinatal HIV-1 transmission. Not only the overall rate of transmission but the impact of different risk factors for transmission appear to vary over the course of HIV infection.
St Louis
M E
ME
Projet SIDA, Kinshasa, Zaire.
Kamenga
M
M
Brown
C
C
Nelson
A M
AM
Manzila
T
T
Batter
V
V
Behets
F
F
Kabagabo
U
U
Ryder
R W
RW
Oxtoby
M
M
D015492:AIDS Serodiagnosis; D000328:Adult; D015496:CD4-Positive T-Lymphocytes; D002821:Chorioamnionitis / Q000276:immunology / Q000473:pathology; D015023:Democratic Republic of the Congo; D005260:Female; D015658:HIV Infections / Q000151:congenital / Q000276:immunology / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D016015:Logistic Models; D015999:Multivariate Analysis; D010920:Placenta / Q000276:immunology* / Q000473:pathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology; D011256:Pregnancy Outcome; D011297:Prenatal Exposure Delayed Effects; D011446:Prospective Studies; D012307:Risk Factors