Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort.
OBJECTIVE
To identify factors associated with mother-to-child HIV-1 transmission (MTCT) from mothers receiving antenatal antiretroviral therapy.


METHODS
The French Perinatal Cohort (EPF), a multicenter prospective cohort of HIV-infected pregnant women and their children.


METHODS
Univariate analysis and logistic regression, with child HIV status as dependent variable, were conducted among 5271 mothers who received antiretroviral therapy during pregnancy, delivered between 1997 and 2004 and did not breastfeed.


RESULTS
The MTCT rate was 1.3% [67/5271; 95% confidence interval (CI), 1.0-1.6]. It was as low as 0.4% (5/1338; 95% CI, 0.1-0.9) in term births with maternal HIV-1 RNA level at delivery below 50 copies/ml. MTCT increased with viral load, short duration of antiretroviral therapy, female gender and severe premature delivery: 6.6% before 33 weeks versus 1.2% at 37 weeks or more (P < 0.001). The type of antiretroviral therapy was not associated with transmission. Intrapartum therapy was associated with four-fold lower MTCT (P = 0.04) in case of virological failure (> 10 000 copies/ml). Elective cesarean section tended to be inversely associated with MTCT in the overall population, but not in mothers who delivered at term with viral load < 400 copies/ml [odds ratio (OR), 0.83; 95% CI, 0.29-2.39; P = 0.37]. Among them, only duration of antenatal therapy was associated with transmission (OR by week, 0.94; 95% CI, 0.90-0.99; P = 0.03).


CONCLUSIONS
Low maternal plasma viral load is the key factor for preventing MTCT. Benefits in terms of MTCT reduction may be expected from early antiretroviral prophylaxis. The potential toxicity of prolonged antiretroviral use in pregnancy should be evaluated.
Warszawski
Josiane
J
Inserm, U822, IFR 60, Le Kremlin-Bicêtre, France. warszaws@vjf.inserm.fr
Tubiana
Roland
R
Le Chenadec
Jerome
J
Blanche
Stephane
S
Teglas
Jean-Paul
JP
Dollfus
Catherine
C
Faye
Albert
A
Burgard
Marianne
M
Rouzioux
Christine
C
Mandelbrot
Laurent
L
D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001903:Bottle Feeding; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control*; D047928:Premature Birth; D012044:Regression Analysis; D018571:Sentinel Surveillance; D012737:Sex Factors; D019562:Viral Load
D019380:Anti-HIV Agents