title: Risk for perinatal HIV-1 transmission according to maternal immunologic, virologic, and placental factors.
abstract: 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.
authors.affiliation: Projet SIDA, Kinshasa, Zaire.
authors.forename: M E
authors.initials: ME
authors.lastname: St Louis
authors.forename: M
authors.initials: M
authors.lastname: Kamenga
authors.forename: C
authors.initials: C
authors.lastname: Brown
authors.forename: A M
authors.initials: AM
authors.lastname: Nelson
authors.forename: T
authors.initials: T
authors.lastname: Manzila
authors.forename: V
authors.initials: V
authors.lastname: Batter
authors.forename: F
authors.initials: F
authors.lastname: Behets
authors.forename: U
authors.initials: U
authors.lastname: Kabagabo
authors.forename: R W
authors.initials: RW
authors.lastname: Ryder
authors.forename: M
authors.initials: M
authors.lastname: Oxtoby
mesh_terms: 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