title: Low rates of mother-to-child transmission of HIV-1 and risk factors for infection in Spain: 2000-2007.
abstract: BACKGROUND
  The objective of the study was to describe temporal patterns in the management of HIV-1 infected women and their newborns and the changes over time in the mother-to-child transmission (MTCT) rates and risk factors.
  
  
  METHODS
  A multicenter prospective observational study was performed in Madrid, Spain, from 2000 to 2007. Cohort period 1 (CP1) included births in 2000-2003 and cohort period 2 (CP2) included births in 2004-2007.
  
  
  RESULTS
  Of the 803 HIV-infected women and their infants, 427 were in the CP1 and 376 in CP2. Almost all CP2 women received highly active antiretroviral therapy. More women in CP2 received antiretroviral treatment for ≥16 weeks during pregnancy (72.0% in CP1 vs. 84.8% in CP2; P < 0.001). Overall, no differences in trends in mode of delivery were observed. The proportion of women with vaginal deliveries who had undetectable viral loads increased from 31.1% in CP1 to 42.7% in CP2 (P = 0.02). Thirteen children (1.6%, 95% confidence interval: 0.68-2.55) were HIV-1 infected by MTCT. No changes in the rates of infection were observed over time. All the cases of MTCT occurred when antiretroviral treatment was not given or was given for <16 weeks during pregnancy.
  
  
  CONCLUSIONS
  Low MTCT rates were observed over time. Lack of timely provision of antiretroviral drugs was the main limitation to develop all preventive interventions available nowadays. Nonsustained control of viral load could be associated with residual transmission.
authors.affiliation: Department of Pediatrics, Hospital Universitario de GetafeServicio de Pediatría, Carretera de Toledo, km 12.500, 28905 Getafe, Madrid, Spain. lmprieto.hugf@salud.madrid.org
authors.forename: Luis Manuel
authors.initials: LM
authors.lastname: Prieto
authors.forename: María-Isabel
authors.initials: MI
authors.lastname: González-Tomé
authors.forename: Eloy
authors.initials: E
authors.lastname: Muñoz
authors.forename: María
authors.initials: M
authors.lastname: Fernández-Ibieta
authors.forename: Beatriz
authors.initials: B
authors.lastname: Soto
authors.forename: Teresa
authors.initials: T
authors.lastname: Del Rosal
authors.forename: Irene
authors.initials: I
authors.lastname: Cuadrado
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Navarro
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Roa
authors.forename: José
authors.initials: J
authors.lastname: Beceiro
authors.forename: María Isabel
authors.initials: MI
authors.lastname: de José
authors.forename: María José
authors.initials: MJ
authors.lastname: Santos
authors.forename: David
authors.initials: D
authors.lastname: Lora
authors.forename: José Tomás
authors.initials: JT
authors.lastname: Ramos
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission*; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control / Q000706:statistics & numerical data*; D008297:Male; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D011446:Prospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents