title: No perinatal HIV-1 transmission from women with effective antiretroviral therapy starting before conception.
abstract: BACKGROUND
  The efficacy of preventing perinatal transmission (PT) of human immunodeficiency virus type 1 (HIV-1) depends on both viral load (VL) and treatment duration. The objective of this study was to determine whether initiating highly active antiretroviral therapy (ART) before conception has the potential to eliminate PT.
  
  
  METHODS
  A total of 8075 HIV-infected mother/infant pairs included from 2000 to 2011 in the national prospective multicenter French Perinatal Cohort (ANRS-EPF) received ART, delivered live-born children with determined HIV infection status, and did not breastfeed. PT was analyzed according to maternal VL at delivery and timing of ART initiation.
  
  
  RESULTS
  The overall rate of PT was 0.7% (56 of 8075). No transmission occurred among 2651 infants born to women who were receiving ART before conception, continued ART throughout the pregnancy, and delivered with a plasma VL <50 copies/mL (upper 95% confidence interval [CI], 0.1%). VL and timing of ART initiation were independently associated with PT in logistic regression. Regardless of VL, the PT rate increased from 0.2% (6 of 3505) for women starting ART before conception to 0.4% (3 of 709), 0.9% (24 of 2810), and 2.2% (23 of 1051) for those starting during the first, second, or third trimester (P < .001). Regardless of when ART was initiated, the PT rate was higher for women with VLs of 50-400 copies/mL near delivery than for those with <50 copies/mL (adjusted odds ratio, 4.0; 95% CI, 1.9-8.2).
  
  
  CONCLUSIONS
  Perinatal HIV-1 transmission is virtually zero in mothers who start ART before conception and maintain suppression of plasma VL.
authors.affiliation: Obstetrics-Gynecology Department, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, Colombes CESP, INSERM U1018 Université Paris Diderot Risks in Pregnancy University Department.
authors.forename: Laurent
authors.initials: L
authors.lastname: Mandelbrot
authors.affiliation: Infectious Diseases Department, Hôpital Pitié Salpétrière and Université Pierre et Marie Curie INSERM- UMR_S 943 Pierre Louis Institute of Epidemiology and Public Health.
authors.forename: Roland
authors.initials: R
authors.lastname: Tubiana
authors.affiliation: CESP, INSERM U1018.
authors.forename: Jerome
authors.initials: J
authors.lastname: Le Chenadec
authors.affiliation: Pediatric Hemato-Oncology Department, Hôpital Trousseau.
authors.forename: Catherine
authors.initials: C
authors.lastname: Dollfus
authors.affiliation: Université Paris Diderot Infectious Diseases Department, Bichat-Claude Bernard, Hôpitaux Universitaires Paris Nord Val de Seine.
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
authors.affiliation: Risks in Pregnancy University Department, Obstetrics-Gynecology Department, Hôpital Cochin Port Royal.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Pannier
authors.affiliation: Université Paris Diderot Pediatrics Department, Hôpital Robert Debré
authors.forename: Sophie
authors.initials: S
authors.lastname: Matheron
authors.affiliation: Infectious Diseases Department, Hôpital Delafontaine, Saint Denis.
authors.forename: Marie-Aude
authors.initials: MA
authors.lastname: Khuong
authors.affiliation: Internal Medicine Department, Hôpital Intercommunal de Créteil.
authors.forename: Valerie
authors.initials: V
authors.lastname: Garrait
authors.affiliation: Infectious Diseases Department, Centre Hospitalier Universitaire de Nantes.
authors.forename: Veronique
authors.initials: V
authors.lastname: Reliquet
authors.affiliation: Infectious Diseases Department, Hôpital Sud Francilien, Evry.
authors.forename: Alain
authors.initials: A
authors.lastname: Devidas
authors.affiliation: Obstetrics-Gynecology Department, Centre Hospitalier Universitaire de Toulouse, Maternité Paule de Viguier.
authors.forename: Alain
authors.initials: A
authors.lastname: Berrebi
authors.affiliation: Pediatrics Department, Hôpital d'Argenteuil.
authors.forename: Christine
authors.initials: C
authors.lastname: Allisy
authors.affiliation: Pediatrics Department, Centre Hospitalier Universitaire de Bordeaux.
authors.forename: Christophe
authors.initials: C
authors.lastname: Elleau
authors.affiliation: Infectious Diseases Department, Centre Hospitalier Universitaire de Rennes, France.
authors.forename: Cedric
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: EA 3610 INSERM Virology Laboratory.
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.affiliation: CESP, INSERM U1018 Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris Université Paris Sud, Le Kremlin-Bicêtre.
authors.forename: Josiane
authors.initials: J
authors.lastname: Warszawski
authors.affiliation: EA Pharmacologie, INSERM, Université Paris Descartes, Sorbonne Paris-Cité Pediatric Immunology Department, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Blanche
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D001769:Blood / Q000821:virology; D015331:Cohort Studies; D004334:Drug Administration Schedule; D005260:Female; D005306:Fertilization; D005500:Follow-Up Studies; D005602:France; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control* / Q000706:statistics & numerical data; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy*; D011446:Prospective Studies; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; antiretroviral therapy; mother-to-child transmission; pregnancy; treatment as prevention