Characteristics of HIV-infected women who do not receive preventive antiretroviral therapy in the French Perinatal Cohort.
OBJECTIVE
To determine the percentage and the profile of women with known HIV-1 seropositivity who do not receive the prepartum phase of preventive treatment for maternofetal transmission.


METHODS
An observational study was conducted as part of the French Perinatal Cohort, an ongoing nationwide cohort of HIV-infected women and their children (followed from birth). This analysis was restricted to women who were delivered between 1996 and 1999.


RESULTS
Among the 2167 women studied, 92 (4.3%) did not receive the prepartum phase of preventive treatment. This proportion fell below 10% in 1996 and subsequently stabilized at 3% to 4%. The reasons for nontreatment were the woman's refusal (34%), premature delivery (8%, before initiation of planned treatment), late diagnosis of maternal HIV infection (3%, at the time of delivery), or unmonitored pregnancy (54%). One third of the women in this latter category were aware of their seropositivity before becoming pregnant. Treated and untreated women did not differ in terms of the usual parameters of HIV infection, geographic origin (sub-Saharan Africa vs. Europe), or HIV transmission category (sexual vs. intravenous [IV] drug use). Untreated women were also less likely than treated women to receive other preventive measures such as intrapartum IV zidovudine infusion, treatment of the newborn, and formula feeding. Indirect evidence strongly suggested that the untreated women were socially marginalized.


CONCLUSIONS
The prepartum phase of preventive treatment for maternofetal transmission is well accepted by HIV-seropositive women in France. The proportion of women who do not receive this treatment could be further reduced by earlier screening (before or at the beginning of pregnancy) and by focusing on a small subgroup of socially marginalized women.
INSERM U569, Hôpital de Bicêtre, 82 rue du Général Leclerc, 94276 Le Kremlin Bicêtre Cedex, Paris, France. mayaux@vjf.inserm.fr
Marie Jeanne
MJ
Mayaux
Jean Paul
JP
Teglas
Stephane
S
Blanche
D000328:Adult; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005602:France; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission* / Q000821:virology; D015497:HIV-1; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology* / Q000821:virology*; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D015215:Zidovudine / Q000627:therapeutic use*
D004279:DNA, Viral; D018894:Reverse Transcriptase Inhibitors; D015215:Zidovudine