Antiretroviral prophylaxis to prevent perinatal HIV transmission in St. Petersburg, Russia: too little, too late.
BACKGROUND
We evaluated the influence of type and timing of prophylaxis on perinatal HIV transmission in St. Petersburg, Russia.


METHODS
We linked surveillance data for 1498 HIV-infected mothers delivering from 2004 to 2007 with polymerase chain reaction data for 1159 infants to determine predictors of transmission.


RESULTS
The overall perinatal transmission rate was 6.3% [73 of 1159, 95% confidence interval (CI) 4.9% to 7.7%]. Among the 12.8% (n = 149) of mother-infant pairs receiving full course (antenatal, intrapartum, postnatal) dual/triple antiretroviral prophylaxis, the transmission rate was 2.7%. Among the 1010 receiving less complete regimens (full course zidovudine, single-dose nevirapine, or incomplete), transmission ranged from 4.1% to 12.2%. Among the 28.9% (330) of mothers initiating antiretroviral drugs <or=20 weeks gestation, perinatal transmission was 1.8%, compared with 4.0%, 8.6%, and 11.3% for those initiating antiretrovirals at 21-28 weeks, 29-42 weeks, or during labor and delivery, respectively (P for trend <0.0001). Compared with those initiating antepartum prophylaxis <or=20 weeks, those initiating antepartum prophylaxis >or=29 weeks (or not at all) had increased transmission odds (adjusted odds ratio: 4.9, 95% CI: 1.8 to 12.9; odds ratio: 5.1, 95% CI: 2.0 to 13.1, respectively).


CONCLUSIONS
In St. Petersburg, the potential for further reductions in perinatal transmission is evident, given low transmission among women receiving early combination prophylaxis.
Hillis
Susan D
SD
Division of Reproductive Health, NCCDPH, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. shillis@cdc.gov
Kuklina
Elena
E
Akatova
Natalia
N
Kissin
Dmitry M
DM
Vinogradova
Elena N
EN
Rakhmanova
Aza G
AG
Stepanova
Elena
E
Jamieson
Denise J
DJ
Robinson
Joanna
J
Vitek
Charles
C
Miller
William C
WC
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D015999:Multivariate Analysis; D011247:Pregnancy; D012426:Russia / Q000453:epidemiology; D018571:Sentinel Surveillance; D019562:Viral Load; D055815:Young Adult
D019380:Anti-HIV Agents