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Previous Volume 341:394-402 August 5, 1999 Number 6 Next

	Full Text PDF Editorial by Rogers, M. F. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background The importance of plasma levels of human immunodeficiency virus type 1 (HIV-1) RNA in pregnant women in relation to the other factors known to influence the risk of transmission of infection to their infants is incompletely defined. We studied the relation of maternal plasma HIV-1 RNA levels to the risk of perinatal transmission and the timing of transmission.

Methods We measured plasma HIV-1 RNA serially in 552 women with HIV-1 infection who had singleton pregnancies. The status of infection in their infants was assessed by culture of blood and further classified as early (if a culture of blood obtained within the first two days of life was positive) or late (if a culture of blood obtained in the first seven days of life was negative but subsequent cultures were positive). The rates of transmission at various levels of maternal plasma HIV-1 RNA were analyzed by tests for trend, with adjustment for covariates by stratification and logistic regression.

Results Increasing geometric mean levels of plasma HIV-1 RNA were associated with increasing rates of transmission: the rate was 0 percent among women with less than 1000 copies per milliliter (0 of 57), 16.6 percent among women with 1000 to 10,000 copies per milliliter (32 of 193), 21.3 percent among women with 10,001 to 50,000 copies per milliliter (39 of 183), 30.9 percent among women with 50,001 to 100,000 copies per milliliter (17 of 54), and 40.6 percent among women with more than 100,000 copies per milliliter (26 of 64, P<0.001). The treatment status of one woman was unknown. The highest rate of transmission was among women whose plasma HIV-1 RNA levels exceeded 100,000 copies per milliliter and who had not received zidovudine (19 of 30 women, 63.3 percent). Neither higher HIV-1 RNA levels early in pregnancy nor higher levels late in pregnancy were associated with the timing of infection in the infants.

Conclusions In pregnant women with HIV-1 infection, the level of plasma HIV-1 RNA predicts the risk but not the timing of transmission of HIV-1 to their infants.

Source Information

From the Department of Obstetrics and Gynecology, Northwestern University, Chicago (P.M.G.); New England Research Institutes, Watertown, Mass. (L.A.K.); the Department of Pediatrics, Columbia College of Physicians and Surgeons, New York (J.P.); the Department of Obstetrics and Gynecology, State University of New York Health Science Center, Brooklyn (H.M.); Johns Hopkins University, Baltimore (T.C.Q., B.J.); the National Institute of Allergy and Infectious Diseases, Bethesda, Md. (T.C.Q., J.F.L.); the Department of Pediatrics, Harvard Medical School, Boston (S.K.B.); Roche Molecular Systems, Alameda, Calif. (J.K.); the National Institute of Child Health and Human Development, Bethesda, Md. (J.M.); the Section of Allergy and Immunology, Baylor College of Medicine, Houston (C.H.); and the Department of Obstetrics and Gynecology, University of Puerto Rico, San Juan (C.Z.). Presented in part at the meeting of the Society of Perinatal Obstetricians, Miami, February 5, 1998.

Address reprint requests to Dr. Garcia at Rm. 410, Prentice Women's Hospital, 333 E. Superior St., Chicago, IL 60611, or at p-garcia{at}nwu.edu.

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