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Volume 341:385-393 August 5, 1999 Number 6 Next

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

ABSTRACT

Background Maternal, obstetrical, and infant-related factors associated with the risk of perinatal transmission of human immunodeficiency virus type 1 (HIV-1) were identified before the widespread use of zidovudine therapy in pregnant women. The risk factors for transmission when women and infants receive zidovudine are not well characterized.

Methods We examined the effects of maternal, obstetrical, and infant-related characteristics and maternal virologic and immunologic variables on the risk of perinatal transmission of HIV-1 among 480 women and their infants, all of whom received zidovudine. The women and infants were participating in a phase 3 trial of passive immunoprophylaxis for the prevention of perinatal transmission.

Results In univariate analyses, the risk of perinatal transmission was associated with each of the following: decreased maternal CD4+ lymphocyte counts at base line; decreased maternal HIV-1 p24 antibody levels at base line and delivery; increased maternal HIV-1 titer at base line and delivery; increased maternal HIV-1 RNA levels at base line and delivery; and the presence of chorioamnionitis at delivery. In multivariate analyses, the only independent risk factor was the maternal HIV-1 RNA level at base line (odds ratio for transmission, 2.4 per log increase in the number of copies; 95 percent confidence interval, 1.2 to 4.7; P=0.02) and at delivery (odds ratio, 3.4; 95 percent confidence interval, 1.7 to 6.8; P=0.001). There was no perinatal transmission of HIV-1 among the 84 women who had HIV-1 levels below the limit of detection (500 copies per milliliter) at base line or the 107 women who had undetectable levels at delivery.

Conclusions Among pregnant women and their infants, all treated with zidovudine, the maternal plasma HIV-1 RNA level was the best predictor of the risk of perinatal transmission of HIV-1. Antiretroviral therapy that reduces the HIV-1 RNA level to below 500 copies per milliliter appears to minimize the risk of perinatal transmission as well as improve the health of the women.

Source Information

From the Pediatric, Adolescent and Maternal AIDS Branch (L.M.M., J.M.), and the Contraceptive and Reproductive Health Branch (P.R.), National Institute of Child Health and Human Development; the Division of AIDS, National Institute of Allergy and Infectious Diseases (M.G.F., B.J.M.); and the Division of Blood Diseases and Resources, National Heart, Lung, and Blood Institute (G.J.N.) — all at the National Institutes of Health, Bethesda, Md.; the Institute of Human Virology, University of Maryland, Baltimore (J.S.L.); UCLA Medical Center, Los Angeles (E.R.S.); Westat, Rockville, Md. (J.B., J.W., D.R.H.); and Quest Diagnostics, Baltimore (W.A.M.). Presented in part at the 12th World AIDS Conference, Geneva, June 28–July 3, 1998.

Address reprint requests to Dr. Mofenson at the Pediatric, Adolescent and Maternal AIDS Branch, National Institute of Child Health and Human Development, 6100 Executive Blvd., Rm. 4B11, Rockville, MD 20852, or at lm65d{at}nih.gov.

Full Text of this Article

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Maternal Viral Load and the Risk of Perinatal Transmission of HIV-1
Ioannidis J. P.A., Contopoulos-Ioannidis D. G., Mofenson L. M., Lambert J. S., Stiehm E. R., Garcia P. M., Moye J., Lew J. F.
Extract | Full Text  
N Engl J Med 1999; 341:1698-1700, Nov 25, 1999. Correspondence

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