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Management of human immunodeficiency virus-infected pregnant women at Latin American and Caribbean sites.
Obstet Gynecol. 2007 Jun; 109(6):1358-67.OG

Abstract

OBJECTIVE

To describe the management of a population of human immunodeficiency virus (HIV)-infected pregnant women in Latin America and the Caribbean, and to assess factors associated with maternal viral load of 1,000 copies/mL or more and with infant HIV-1 infection.

METHODS

Eligibility criteria were enrollment in the prospective cohort study as of March 2006; delivery of a liveborn, singleton infant; and completion of the 6-month postpartum or postnatal visit.

RESULTS

Of 955 women enrolled in Argentina, the Bahamas, Brazil, and Mexico, 770 mother-infant pairs were eligible. At enrollment, most women were relatively healthy (87% asymptomatic, 59% with viral load less than 1,000 copies/mL, 62% with CD4(+)% of 25% or more). Most (99%) received antiretrovirals during pregnancy (56% prophylaxis, 44% treatment), and 38% delivered by cesarean before labor and before ruptured membranes. Only 18% of women had a viral load of 1,000 copies/mL or more after delivery (associated in adjusted analyses with receipt of antiretrovirals at conception, CD4(+)% [lower], viral load [higher], and country at enrollment, enrollment late in pregnancy, and inversely related to antiretroviral regimen [two nucleoside or nucleotide analogue reverse transcriptase inhibitors plus one nonnucleoside reverse transcriptase inhibitor] during pregnancy). None of the infants breastfed, and all received antiretroviral prophylaxis. Seven infants became infected (0.91%; 95% confidence interval 0.37-1.86). Low birth weight infants and those whose mothers had a low CD4(+)% at hospital discharge after delivery and were not receiving antiretrovirals at enrollment were at higher risk of HIV infection.

CONCLUSION

Only a minority of women had a viral load of 1,000 copies/mL or more around delivery, and mother-to-child transmission of HIV occurred rarely (1%).

Authors+Show Affiliations

National Institute of Child Health and Human Development, Bethesda, Maryland, USA. jennifer_read@nih.govNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17540808

Citation

Read, Jennifer S., et al. "Management of Human Immunodeficiency Virus-infected Pregnant Women at Latin American and Caribbean Sites." Obstetrics and Gynecology, vol. 109, no. 6, 2007, pp. 1358-67.
Read JS, Cahn P, Losso M, et al. Management of human immunodeficiency virus-infected pregnant women at Latin American and Caribbean sites. Obstet Gynecol. 2007;109(6):1358-67.
Read, J. S., Cahn, P., Losso, M., Pinto, J., Joao, E., Duarte, G., Cardoso, E., Freimanis-Hance, L., & Stoszek, S. K. (2007). Management of human immunodeficiency virus-infected pregnant women at Latin American and Caribbean sites. Obstetrics and Gynecology, 109(6), 1358-67.
Read JS, et al. Management of Human Immunodeficiency Virus-infected Pregnant Women at Latin American and Caribbean Sites. Obstet Gynecol. 2007;109(6):1358-67. PubMed PMID: 17540808.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Management of human immunodeficiency virus-infected pregnant women at Latin American and Caribbean sites. AU - Read,Jennifer S, AU - Cahn,Pedro, AU - Losso,Marcelo, AU - Pinto,Jorge, AU - Joao,Esau, AU - Duarte,Geraldo, AU - Cardoso,Edmundo, AU - Freimanis-Hance,Laura, AU - Stoszek,Sonia K, AU - ,, PY - 2007/6/2/pubmed PY - 2007/7/10/medline PY - 2007/6/2/entrez SP - 1358 EP - 67 JF - Obstetrics and gynecology JO - Obstet Gynecol VL - 109 IS - 6 N2 - OBJECTIVE: To describe the management of a population of human immunodeficiency virus (HIV)-infected pregnant women in Latin America and the Caribbean, and to assess factors associated with maternal viral load of 1,000 copies/mL or more and with infant HIV-1 infection. METHODS: Eligibility criteria were enrollment in the prospective cohort study as of March 2006; delivery of a liveborn, singleton infant; and completion of the 6-month postpartum or postnatal visit. RESULTS: Of 955 women enrolled in Argentina, the Bahamas, Brazil, and Mexico, 770 mother-infant pairs were eligible. At enrollment, most women were relatively healthy (87% asymptomatic, 59% with viral load less than 1,000 copies/mL, 62% with CD4(+)% of 25% or more). Most (99%) received antiretrovirals during pregnancy (56% prophylaxis, 44% treatment), and 38% delivered by cesarean before labor and before ruptured membranes. Only 18% of women had a viral load of 1,000 copies/mL or more after delivery (associated in adjusted analyses with receipt of antiretrovirals at conception, CD4(+)% [lower], viral load [higher], and country at enrollment, enrollment late in pregnancy, and inversely related to antiretroviral regimen [two nucleoside or nucleotide analogue reverse transcriptase inhibitors plus one nonnucleoside reverse transcriptase inhibitor] during pregnancy). None of the infants breastfed, and all received antiretroviral prophylaxis. Seven infants became infected (0.91%; 95% confidence interval 0.37-1.86). Low birth weight infants and those whose mothers had a low CD4(+)% at hospital discharge after delivery and were not receiving antiretrovirals at enrollment were at higher risk of HIV infection. CONCLUSION: Only a minority of women had a viral load of 1,000 copies/mL or more around delivery, and mother-to-child transmission of HIV occurred rarely (1%). SN - 0029-7844 UR - https://www.unboundmedicine.com/medline/citation/17540808/Management_of_human_immunodeficiency_virus_infected_pregnant_women_at_Latin_American_and_Caribbean_sites_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=17540808.ui DB - PRIME DP - Unbound Medicine ER -