Maternal plasma human immunodeficiency virus type 1 RNA level: a determinant and projected threshold for mother-to-child transmission.
To prevent mother-to-child human immunodeficiency virus type 1 (HIV-1) transmission, it is important to identify its determinants. Because HIV-1 RNA levels can be reduced by antiviral therapy, we examined the role of maternal plasma HIV-1 RNA level in mother-to-child transmission. We used quantitative competitive PCR to measure HIV-RNA in 30 infected pregnant women and then followed their infants prospectively; 27% of the women transmitted HIV-1 to their infants and maternal plasma HIV-1 RNA level correlated strikingly with transmission. Eight of the 10 women with the highest HIV-1 RNA levels at delivery (190,400-1,664,100 copies per ml of plasma) transmitted, while none of the 20 women with lower levels (500-155,800 copies per ml) did (P = 0.0002). Statistical analysis of the distribution of HIV-1 RNA loads in these 30 women projected a threshold for mother-to-child transmission in a larger population; the probability of a woman with a viral RNA level of < or = 100,000 copies per ml not transmitting is predicted to be 97%. Examination of serial HIV-1 RNA levels during pregnancy showed that viral load was stable in women who did not initiate or change antiviral therapy. These data identify maternal plasma HIV-1-RNA level as a major determinant of mother-to-child transmission and suggest that quantitation of HIV-1 RNA may predict the risk of transmission.
Fang
G
G
Wadsworth Center, New York State Department of Health, Albany, USA.
Burger
H
H
Grimson
R
R
Tropper
P
P
Nachman
S
S
Mayers
D
D
Weislow
O
O
Moore
R
R
Reyelt
C
C
Hutcheon
N
N
Baker
D
D
Weiser
B
B
D000163:Acquired Immunodeficiency Syndrome / Q000097:blood / Q000517:prevention & control / Q000635:transmission*; D000293:Adolescent; D000328:Adult; D036861:Delivery, Obstetric; D004352:Drug Resistance, Microbial; D005260:Female; D005865:Gestational Age; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007743:Labor, Obstetric; D016133:Polymerase Chain Reaction / Q000379:methods*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood* / Q000821:virology; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D015215:Zidovudine / Q000627:therapeutic use
D012367:RNA, Viral; D015215:Zidovudine