title: Missed opportunities for prevention of mother-to-child transmission of HIV-1 in the NISDI Perinatal and LILAC cohorts.
abstract: OBJECTIVE
  To evaluate cases of mother-to-child transmission of HIV-1 at multiple sites in Latin America and the Caribbean in terms of missed opportunities for prevention.
  
  
  METHODS
  Pregnant women infected with HIV-1 were eligible for inclusion if they were enrolled in either the NISDI Perinatal or LILAC protocols by October 20, 2009, and had delivered a live infant with known HIV-1 infection status after March 1, 2006.
  
  
  RESULTS
  Of 711 eligible mothers, 10 delivered infants infected with HIV-1. The transmission rate was 1.4% (95% CI, 0.7-2.6). Timing of transmission was in utero or intrapartum (n=5), intrapartum (n=2), intrapartum or early postnatal (n=1), and unknown (n=2). Possible missed opportunities for prevention included poor control of maternal viral load during pregnancy; late initiation of antiretrovirals during pregnancy; lack of cesarean delivery before labor and before rupture of membranes; late diagnosis of HIV-1 infection; lack of intrapartum antiretrovirals; and incomplete avoidance of breastfeeding.
  
  
  CONCLUSIONS
  Early knowledge of HIV-1 infection status (ideally before or in early pregnancy) would aid timely initiation of antiretroviral treatment and strategies designed to prevent mother-to-child transmission. Use of antiretrovirals must be appropriately monitored in terms of adherence and drug resistance. If feasible, breastfeeding should be completely avoided. Presented in part at the XIX International AIDS Conference (Washington, DC; July 22-27, 2012); abstract WEPE163.
authors: Pediatric, Adolescent, and Maternal AIDS Branch, CRMC, NICHD, NIH, DHHS, Bethesda, USA. jennifer.read@hhs.gov
authors: Jennifer S
authors: JS
authors: Read
authors: Rachel A
authors: RA
authors: Cohen
authors: Laura Freimanis
authors: LF
authors: Hance
authors: Elizabeth S
authors: ES
authors: Machado
authors: Marisa M
authors: MM
authors: Mussi-Pinhata
authors: Mariana
authors: M
authors: Ceriotto
authors: Breno
authors: B
authors: Santos
authors: Regina
authors: R
authors: Succi
authors: Jose H
authors: JH
authors: Pilotto
authors: Jorge O
authors: JO
authors: Alarcon
authors: Regis
authors: R
authors: Kreitchmann
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001942:Breast Feeding; D017691:Caribbean Region; D002585:Cesarean Section; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission*; D015497:HIV-1; D006801:Humans; D007223:Infant; 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*; D019562:Viral Load / Q000187:drug effects
chemical_list: D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents