title: The Ariel Project: A prospective cohort study of maternal-child transmission of human immunodeficiency virus type 1 in the era of maternal antiretroviral therapy.
abstract: In a prospective cohort study, clinical and biologic factors that contribute to maternal-child transmission of human immunodeficiency virus type 1 (HIV-1) were studied. HIV-infected pregnant women and their infants were evaluated prospectively according to a standardized protocol. Of 204 evaluable women, 81% received zidovudine during their pregnancy. The infection rate among the 209 evaluable infants was 9.1%. By univariate analysis, histologic chorioamnionitis, prolonged rupture of membranes, and a history of genital warts were significantly associated with transmission. Additional factors associated with transmission that approached significance included a higher maternal virus load at delivery and the presence of cocaine in the urine. In a logistic regression model, histologic chorioamnionitis was the only independent predictor of transmission. Despite a significantly higher transmission rate at one site, no unique viral genotype was found at any site. Thus, chorioamnionitis was found to be the major risk factor for transmission among women receiving zidovudine.
authors.affiliation: Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA 70112, USA. vandyke@mailhost.tcs.tulane.edu
authors.forename: R B
authors.initials: RB
authors.lastname: Van Dyke
authors.forename: B T
authors.initials: BT
authors.lastname: Korber
authors.forename: E
authors.initials: E
authors.lastname: Popek
authors.forename: C
authors.initials: C
authors.lastname: Macken
authors.forename: S M
authors.initials: SM
authors.lastname: Widmayer
authors.forename: A
authors.initials: A
authors.lastname: Bardeguez
authors.forename: I C
authors.initials: IC
authors.lastname: Hanson
authors.forename: A
authors.initials: A
authors.lastname: Wiznia
authors.forename: K
authors.initials: K
authors.lastname: Luzuriaga
authors.forename: R R
authors.initials: RR
authors.lastname: Viscarello
authors.forename: S
authors.initials: S
authors.lastname: Wolinsky
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000635:transmission*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005312:Fetal Blood / Q000821:virology; D015497:HIV-1 / Q000145:classification; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D015999:Multivariate Analysis; D010802:Phylogeny; D010920:Placenta / Q000473:pathology / Q000821:virology; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D014621:Vagina / Q000821:virology