Acute and chronic chorioamnionitis and the risk of perinatal human immunodeficiency virus-1 transmission.
OBJECTIVE
This study was undertaken to examine the prevalence of acute and chronic chorioamnionitis among women infected with human immunodeficiency virus-1 (HIV-1) and to determine the relative contribution of each to perinatal HIV-1 transmission.


METHODS
In 227 HIV-infected women receiving intrapartum/neonatal nevirapine prophylaxis, we examined associations between fetal membrane histology, cord blood interleukin-6 (IL-6), and perinatal HIV-1 transmission.


RESULTS
Acute chorioamnionitis was present in 122 of 227 specimens; chronic chorioamnionitis in 64 of 227. There was a positive correlation between acute chorioamnionitis and labor length (r = 0.208; P = .002), time of ruptured membrane (r = 0.177; P = .008), and cord IL-6 (r = 0.390; P < .001). Chronic chorioamnionitis was associated with high viral load (P = .05) and low cord IL-6 (P < .001). Severe chronic chorioamnionitis was associated with intrauterine HIV-1 transmission (odds ratio [OR] = 7.61; 95% CI = 1.04-85.5), but no correlation was demonstrated between acute chorioamnionitis and vertical transmission.


CONCLUSIONS
In a setting of high perinatal nevirapine use, acute chorioamnionitis was not associated with vertical HIV-1 transmission. Risk for intrauterine transmission increased significantly when chronic chorioamnionitis was present.
Chi
Benjamin H
BH
School of Medicine, University of Alabama, Birmingham, AL 35294-0024, USA. bchi@uab.edu
Mudenda
Victor
V
Levy
Jens
J
Sinkala
Moses
M
Goldenberg
Robert L
RL
Stringer
Jeffrey S A
JS
D000208:Acute Disease; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D002821:Chorioamnionitis / Q000453:epidemiology*; D002908:Chronic Disease; D005260:Female; D005312:Fetal Blood; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D015850:Interleukin-6 / Q000097:blood; D007743:Labor, Obstetric; D008431:Maternal-Fetal Exchange; D019829:Nevirapine / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011247:Pregnancy; D015995:Prevalence; D018570:Risk Assessment; D013997:Time Factors
D019380:Anti-HIV Agents; D015850:Interleukin-6; D019829:Nevirapine