Management of human immunodeficiency virus-infected pregnant women at Latin American and Caribbean sites.
OBJECTIVE
To describe the management of a population of human immunodeficiency virus (HIV)-infected pregnant women in Latin America and the Caribbean, and to assess factors associated with maternal viral load of 1,000 copies/mL or more and with infant HIV-1 infection.


METHODS
Eligibility criteria were enrollment in the prospective cohort study as of March 2006; delivery of a liveborn, singleton infant; and completion of the 6-month postpartum or postnatal visit.


RESULTS
Of 955 women enrolled in Argentina, the Bahamas, Brazil, and Mexico, 770 mother-infant pairs were eligible. At enrollment, most women were relatively healthy (87% asymptomatic, 59% with viral load less than 1,000 copies/mL, 62% with CD4(+)% of 25% or more). Most (99%) received antiretrovirals during pregnancy (56% prophylaxis, 44% treatment), and 38% delivered by cesarean before labor and before ruptured membranes. Only 18% of women had a viral load of 1,000 copies/mL or more after delivery (associated in adjusted analyses with receipt of antiretrovirals at conception, CD4(+)% [lower], viral load [higher], and country at enrollment, enrollment late in pregnancy, and inversely related to antiretroviral regimen [two nucleoside or nucleotide analogue reverse transcriptase inhibitors plus one nonnucleoside reverse transcriptase inhibitor] during pregnancy). None of the infants breastfed, and all received antiretroviral prophylaxis. Seven infants became infected (0.91%; 95% confidence interval 0.37-1.86). Low birth weight infants and those whose mothers had a low CD4(+)% at hospital discharge after delivery and were not receiving antiretrovirals at enrollment were at higher risk of HIV infection.


CONCLUSIONS
Only a minority of women had a viral load of 1,000 copies/mL or more around delivery, and mother-to-child transmission of HIV occurred rarely (1%).
Read
Jennifer S
JS
National Institute of Child Health and Human Development, Bethesda, Maryland, USA. jennifer_read@nih.gov
Cahn
Pedro
P
Losso
Marcelo
M
Pinto
Jorge
J
Joao
Esau
E
Duarte
Geraldo
G
Cardoso
Edmundo
E
Freimanis-Hance
Laura
L
Stoszek
Sonia K
SK
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D018791:CD4 Lymphocyte Count; D017691:Caribbean Region; D002585:Cesarean Section; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission* / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007843:Latin America; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy* / Q000821:virology; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome; D019562:Viral Load
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents; D018894:Reverse Transcriptase Inhibitors