title: Duration of membrane rupture and risk of perinatal transmission of HIV-1 in the era of combination antiretroviral therapy.
abstract: OBJECTIVE
  The objective of the study was to determine whether the duration of membrane rupture of 4 or more hours is a significant risk factor for perinatal transmission of human immunodeficiency virus (HIV) in the era of combination antiretroviral therapy (ART).
  
  
  METHODS
  This was a prospective cohort study of 717 HIV-infected pregnant women-infant pairs with a delivery viral load available who received prenatal care and delivered at our institution during the interval 1996-2008.
  
  
  RESULTS
  The cohort comprised 707 women receiving ART who delivered during this interval. The perinatal transmission rate was 1% in women with membranes ruptured for less than 4 hours and 1.9% when ruptured for 4 or more hours. For 493 women with a delivery viral load less than 1000 copies/mL receiving combination ART in pregnancy, there were no cases of perinatal transmission identified up to 25 hours of membrane rupture. Logistic regression demonstrated only a viral load above 10,000 copies/mL as an independent risk factor for perinatal transmission.
  
  
  CONCLUSIONS
  Duration of membrane rupture of 4 or more hours is not a risk factor for perinatal transmission of HIV in women with a viral load less than 1000 copies/mL receiving combination ART.
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA. Amanda.Cotter@ul.ie
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Cotter
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Brookfield
authors.forename: Lunthita M
authors.initials: LM
authors.lastname: Duthely
authors.forename: Victor H
authors.initials: VH
authors.lastname: Gonzalez Quintero
authors.forename: JoNell E
authors.initials: JE
authors.lastname: Potter
authors.forename: Mary J
authors.initials: MJ
authors.lastname: O'Sullivan
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D015331:Cohort Studies; D004338:Drug Combinations; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy / Q000821:virology*; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000472:pathogenicity*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D004338:Drug Combinations