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Volume 334:1617-1623 June 20, 1996 Number 25 Next

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ABSTRACT

Background A substantial proportion of perinatally acquired infections with the human immunodeficiency virus type 1 (HIV-1) occur at or near delivery, which suggests that obstetrical factors may have an important influence on transmission. We evaluated the relation of such factors and other variables to the perinatal transmission of HIV-1.

Methods The Women and Infants Transmission Study is a prospective, observational study of HIV-1–infected women who were enrolled during pregnancy and followed with their infants for three years after delivery. We studied obstetrical, clinical, immunologic, and virologic data on 525 women who delivered live singleton infants whose HIV-1–infection status was known as of August 31, 1994.

Results Among mothers with membranes that ruptured more than four hours before delivery, the rate of transmission of HIV-1 to the infants was 25 percent, as compared with 14 percent among mothers with membranes that ruptured four hours or less before delivery. In a multivariate analysis, the presence of ruptured membranes for more than four hours nearly doubled the risk of transmission (odds ratio, 1.82; 95 percent confidence interval, 1.10 to 3.00; P = 0.02), regardless of the mode of delivery. The other maternal factors independently associated with transmission were illicit-drug use during pregnancy (odds ratio, 1.90; 95 percent confidence interval, 1.14 to 3.16; P = 0.01), low antenatal CD4+ lymphocyte count (<29 percent of total lymphocytes) (odds ratio, 2.82; 1.67 to 4.76; P<0.001), and birth weight <2500 g (odds ratio, 1.86; 1.03 to 3.34; P = 0.04).

Conclusions The risk of transmission of HIV-1 from mother to infant increases when the fetal membranes rupture more than four hours before delivery.

Source Information

From the Department of Medicine, Division of Infectious Disease (S.H.L.), and the Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine (H.M.), State University of New York Health Science Center at Brooklyn, Brooklyn; New England Research Institute, Watertown, Mass. (L.A.K.); the Pediatric Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, Bethesda, Md. (D.N.B., L.M.); the Department of Obstetrics and Gynecology, George Washington University School of Medicine, Washington, D.C. (H.E.F.); the Department of Obstetrics and Gynecology, Medical Science Campus, University of Puerto Rico, San Juan (C.Z.); the Department of Obstetrics and Gynecology, Northwestern University Medical School, Chicago (P.G.); the Vaccine Trials and Epidemiology Branch, National Institute of Allergy and Infectious Diseases, Bethesda, Md. (M.G.F.); and the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston (R.T.).

Address reprint requests to Dr. Landesman at the State University of New York Health Science Center at Brooklyn, 450 Clarkson Ave., Box 122, Brooklyn, NY 11203.

Full Text of this Article

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Prolonged Rupture of Membranes and Transmission of the Human Immunodeficiency Virus
Umans-Eckenhausen M. A.W., Lafeber H. N., Landesman S. H., Burns D. N., Kalish L. A.
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N Engl J Med 1996; 335:1533-1534, Nov 14, 1996. Correspondence

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