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Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1).
Clin Infect Dis. 2010 Feb 15; 50(4):585-96.CI

Abstract

BACKGROUND

The rate of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 is as low as 0.5% in non-breast-feeding mothers who delivered at term while receiving antiretroviral therapy with a plasma viral load <500 copies/mL. This situation accounted for 20% of the infected children born during the period 1997-2006 in the French Perinatal Cohort. We aimed to identify factors associated with such residual transmission risk.

METHODS

We performed a case-control study nested in the aforementioned subpopulation of the French Perinatal Cohort.

RESULTS

Nineteen case patients (transmitters) and 60 control subjects (nontransmitters) were included. Case patients and control subjects did not differ by geographical origin, gestational age at HIV diagnosis, type of antiretroviral therapy received, or elective Cesarean delivery. Case patients were less often receiving treatment at the time that they conceived pregnancy than control subjects (16% vs 45%; P=.017). A lower proportion of case patients had a viral load <500 copies/mL, compared with control subjects, at 14 weeks (0% vs 38.1%; P=.02), 28 weeks (7.7% vs 62.1%; P=.005), and 32 weeks: (21.4% vs 71.1%; P=.004). The difference remained significant when we restricted analysis to the 10 of 16 intrapartum transmission cases. In a multivariate analysis at 30+/-4 weeks adjusted for viral load, CD4(+) T cell count, and time at antiretroviral therapy initiation, viral load was the only factor independently associated with MTCT of HIV (adjusted odds ratio, 23.2; 95% confidence interval, 3.5-553; P<.001).

CONCLUSIONS

Early and sustained control of viral load is associated with a decreasing residual risk of MTCT of HIV-1. Guidelines should take into account not only CD4(+) T cell count and risk of preterm delivery, but also baseline HIV-1 load for deciding when to start antiretroviral therapy during pregnancy.

Authors+Show Affiliations

Département des Maladies Infectieuses et Tropicales, Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Pitié Salpêtrière, France.No 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, Non-U.S. Gov't

Language

eng

PubMed ID

20070234

Citation

Tubiana, Roland, et al. "Factors Associated With Mother-to-child Transmission of HIV-1 Despite a Maternal Viral Load <500 Copies/ml at Delivery: a Case-control Study Nested in the French Perinatal Cohort (EPF-ANRS CO1)." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 50, no. 4, 2010, pp. 585-96.
Tubiana R, Le Chenadec J, Rouzioux C, et al. Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1). Clin Infect Dis. 2010;50(4):585-96.
Tubiana, R., Le Chenadec, J., Rouzioux, C., Mandelbrot, L., Hamrene, K., Dollfus, C., Faye, A., Delaugerre, C., Blanche, S., & Warszawski, J. (2010). Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1). Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 50(4), 585-96. https://doi.org/10.1086/650005
Tubiana R, et al. Factors Associated With Mother-to-child Transmission of HIV-1 Despite a Maternal Viral Load <500 Copies/ml at Delivery: a Case-control Study Nested in the French Perinatal Cohort (EPF-ANRS CO1). Clin Infect Dis. 2010 Feb 15;50(4):585-96. PubMed PMID: 20070234.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with mother-to-child transmission of HIV-1 despite a maternal viral load <500 copies/ml at delivery: a case-control study nested in the French perinatal cohort (EPF-ANRS CO1). AU - Tubiana,Roland, AU - Le Chenadec,Jerome, AU - Rouzioux,Christine, AU - Mandelbrot,Laurent, AU - Hamrene,Karima, AU - Dollfus,Catherine, AU - Faye,Albert, AU - Delaugerre,Constance, AU - Blanche,Stephane, AU - Warszawski,Josiane, PY - 2010/1/15/entrez PY - 2010/1/15/pubmed PY - 2010/4/22/medline SP - 585 EP - 96 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 50 IS - 4 N2 - BACKGROUND: The rate of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) type 1 is as low as 0.5% in non-breast-feeding mothers who delivered at term while receiving antiretroviral therapy with a plasma viral load <500 copies/mL. This situation accounted for 20% of the infected children born during the period 1997-2006 in the French Perinatal Cohort. We aimed to identify factors associated with such residual transmission risk. METHODS: We performed a case-control study nested in the aforementioned subpopulation of the French Perinatal Cohort. RESULTS: Nineteen case patients (transmitters) and 60 control subjects (nontransmitters) were included. Case patients and control subjects did not differ by geographical origin, gestational age at HIV diagnosis, type of antiretroviral therapy received, or elective Cesarean delivery. Case patients were less often receiving treatment at the time that they conceived pregnancy than control subjects (16% vs 45%; P=.017). A lower proportion of case patients had a viral load <500 copies/mL, compared with control subjects, at 14 weeks (0% vs 38.1%; P=.02), 28 weeks (7.7% vs 62.1%; P=.005), and 32 weeks: (21.4% vs 71.1%; P=.004). The difference remained significant when we restricted analysis to the 10 of 16 intrapartum transmission cases. In a multivariate analysis at 30+/-4 weeks adjusted for viral load, CD4(+) T cell count, and time at antiretroviral therapy initiation, viral load was the only factor independently associated with MTCT of HIV (adjusted odds ratio, 23.2; 95% confidence interval, 3.5-553; P<.001). CONCLUSIONS: Early and sustained control of viral load is associated with a decreasing residual risk of MTCT of HIV-1. Guidelines should take into account not only CD4(+) T cell count and risk of preterm delivery, but also baseline HIV-1 load for deciding when to start antiretroviral therapy during pregnancy. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/20070234/Factors_associated_with_mother_to_child_transmission_of_HIV_1_despite_a_maternal_viral_load_<500_copies/ml_at_delivery:_a_case_control_study_nested_in_the_French_perinatal_cohort__EPF_ANRS_CO1__ DB - PRIME DP - Unbound Medicine ER -