[Maternal viral and gestational risk factors in vertical transmission of HIV-1 infection].
BACKGROUND
Several risk factors are related to vertical transfer of HIV-1 infection, but the influence of each one separately is controversial. Various risk factors have been evaluated altogether and separately, in order to find a single condition, that is, early in pregnancy predictive of fetal infection.


METHODS
A prospective, observational study has been carried out during the period January 1992-January 1997, at the Centre for infectious diseases in pregnancy, University Hospital of Bari, a tertiary reference setting. Forty-four HIV-1 infected mothers have been recruited in early pregnancy, to be followed-up until delivery. Neonates have been evaluated in the Pediatric Department of the same hospital until 18 months of age. Maternal risk factors, such as age, infection in the partner, mode of acquisition of HIV-1, drug addition, life-style and risky behaviour as well as stage of disease, immunological status and antiviral treatment were considered. Obstetrical factors, too, (parity, preterm delivery, rupture of membranes, duration of labour and mode of delivery) were taken into account. Data were analyzed according to Fisher exact test and Draper and Smith multivariate analysis.


RESULTS
Thirty cases (9 inadequate for follow-up, 4 ongoing pregnancies, 1 perinatal death before ascertainment of infection) were evaluated for final results. The overall transmission rate was 13.3%. Single factors significantly related to transmission were stage of disease (p < 0.01), mode of maternal infection (p < 0.03) and maternal HCV infection (p < 0.04). Multivariate analysis has shown the stage of disease to be the only positively-related risk-factor.


CONCLUSIONS
The data identify a sub-group among HIV-1 infected women, where the more sustained rate of vertical transmission is associated with risky behaviour, as determined both by drug addiction and positivity for another sexually transmitted disease. Maternal compromise and immunological status are, however, the highest-risk conditions for delivering a HIV-1 infected baby.
Greco
P
P
II Clinica Ostetrica e Ginecologica, Università degli Studi, Bari.
Vimercati
A
A
Fiore
J R
JR
Kardashi
A
A
Lotesoriere
V
V
Loverro
G
G
Milillo
F
F
Selvaggi
L
L
D000163:Acquired Immunodeficiency Syndrome / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000276:immunology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008431:Maternal-Fetal Exchange; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000276:immunology / Q000821:virology*; D012307:Risk Factors; D019966:Substance-Related Disorders