Perinatal transmission of human immunodeficiency virus type 1 by pregnant women with RNA virus loads <1000 copies/ml.
In a collaboration of 7 European and United States prospective studies, 44 cases of vertical human immunodeficiency virus type 1 (HIV-1) transmission were identified among 1202 women with RNA virus loads <1000 copies/mL at delivery or at the measurement closest to delivery. For mothers receiving antiretroviral treatment during pregnancy or at the time of delivery (or both), there was a 1.0% transmission rate (8 of 834; 95% confidence interval [CI], 0.4%-1.9%), compared with 9.8% (36 of 368; 95% CI, 7.0%-13.4%) for untreated mothers (risk ratio, 0.10; 95% CI, 0.05-0.21). In multivariate analysis adjusting for study, transmission was lower with antiretroviral treatment (odds ratio [OR], 0.10; P<.001), cesarean section (OR, 0.30; P=.022), greater birth weight (P=.003), and higher CD4 cell count (P=.039). In 12 of 44 cases, multiple RNA measurements were obtained during pregnancy or at the time of delivery or within 4 months after giving birth; in 10 of the 12 cases, the geometric mean virus load was >500 copies/mL. Perinatal HIV-1 transmission occurs in only 1% of treated women with RNA virus loads <1000 copies/mL and may be almost eliminated with antiretroviral prophylaxis accompanied by suppression of maternal viremia.
Ioannidis
J P
JP
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece. jioannid@cc.uoi.gr
Abrams
E J
EJ
Ammann
A
A
Bulterys
M
M
Goedert
J J
JJ
Gray
L
L
Korber
B T
BT
Mayaux
M J
MJ
Mofenson
L M
LM
Newell
M L
ML
Shapiro
D E
DE
Teglas
J P
JP
Wilfert
C M
CM
D019380:Anti-HIV Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005060:Europe; D005260:Female; D005865:Gestational Age; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D007391:International Cooperation; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000821:virology*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood*; D012042:Registries; D012307:Risk Factors; D014481:United States; D019562:Viral Load; D014766:Viremia
D019380:Anti-HIV Agents; D012367:RNA, Viral