Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy

Claire Thorne; C. Giaquinto; E. Ruga; A. De Rossi; I. Grosch-Worner; J. Mok; I. de Jose; I. Bates; F. Hawkins; C. Ladron de Guevara; J. Ma Pena; J. Gonzalez Garcia; J. R. Arribas Lopez; M. C. Garcia-Rodriguez; F. Asensi-Botet; M. C. Otero; D. Perez-Tamarit; G. Suarez; H. Scherpbier; M. Kreyenbroek; K. Boer; A. B. Bohlin; S. Lindgren; A. Ehrnst; E. Belfrage; L. Naver; K. Lidman; B. Anzen; J. Levy; P. Barlow; M. Hainaut; A. Peltier; T. Goetghebuer; A. Ferrazin; D. Bassetti; A. De Maria; C. Gotta; A. Mur; A. Paya; M. Vinolas; M. A. Lopez-Vilchez; null Rovira; R. Carreras; N. H. Valerius; J. Jimenez; O. Coll; A. Suy; J. M. Perez; C. Fortuny; M. Casellas Caro; Y. Canet; V. Savasi; A. Vigano; E. Ferrazi; S. Alberico; M. Rabusin; M. Bernardon; G. P. Taylor; E. G.H. Lyall; Z. Penn; W. Buffolano; R. Tiseo; P. Martinelli; A. Agangi; C. M. Sansone; C. Tibaldi; S. Marini; G. Masuelli; C. Benedetto; T. Niemiec; M. Marczynska; A. Horban

doi:10.1086/427287

Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy

Claire Thorne, C. Giaquinto, E. Ruga, A. De Rossi, I. Grosch-Worner, J. Mok, I. de Jose, I. Bates, F. Hawkins, C. Ladron de Guevara, J. Ma Pena, J. Gonzalez Garcia, J. R. Arribas Lopez, M. C. Garcia-Rodriguez, F. Asensi-Botet, M. C. Otero, D. Perez-Tamarit, G. Suarez, H. Scherpbier, M. KreyenbroekK. Boer, A. B. Bohlin, S. Lindgren, A. Ehrnst, E. Belfrage, L. Naver, K. Lidman, B. Anzen, J. Levy, P. Barlow, M. Hainaut, A. Peltier, T. Goetghebuer, A. Ferrazin, D. Bassetti, A. De Maria, C. Gotta, A. Mur, A. Paya, M. Vinolas, M. A. Lopez-Vilchez, Rovira, R. Carreras, N. H. Valerius, J. Jimenez, O. Coll, A. Suy, J. M. Perez, C. Fortuny, M. Casellas Caro, Y. Canet, V. Savasi, A. Vigano, E. Ferrazi, S. Alberico, M. Rabusin, M. Bernardon, G. P. Taylor, E. G.H. Lyall, Z. Penn, W. Buffolano, R. Tiseo, P. Martinelli, A. Agangi, C. M. Sansone, C. Tibaldi, S. Marini, G. Masuelli, C. Benedetto, T. Niemiec, M. Marczynska, A. Horban

Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine and Public Health

Research output: Contribution to journal › Article › Research › peer-review

473 Citations (Scopus)

Abstract

Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions. Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during pregnancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis. Results. Receipt of antenatal antiretroviral therapy increased from 5% at the start of the HAART era to 92% in 2001-2003. The overall MTCT rate in this period was 2.87% (95% confidence interval [CI], 2.11%-3.81%), but it was 0.99% (95% CI, 0.32%-2.30%) during 2001-2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1; P = .003) and elective Caesarean section (AOR, 0.33; P = .04). Detection of maternal HIV RNA was significantly associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.03-0.33), compared with vaginal delivery or emergency Caesarean section. Conclusions. Our results suggest that offering an elective Caesarean section delivery to all HIV-infected women, even in areas where HAART is available, is appropriate clinical management, especially for persons with detectable viral loads. Our results also suggest that previously identified risk factors remain important.

Original language	English
Pages (from-to)	458-465
Journal	Clinical Infectious Diseases
Volume	40
Issue number	3
DOIs	https://doi.org/10.1086/427287
Publication status	Published - 1 Feb 2005

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Thorne, C., Giaquinto, C., Ruga, E., De Rossi, A., Grosch-Worner, I., Mok, J., de Jose, I., Bates, I., Hawkins, F., Ladron de Guevara, C., Ma Pena, J., Gonzalez Garcia, J., Arribas Lopez, J. R., Garcia-Rodriguez, M. C., Asensi-Botet, F., Otero, M. C., Perez-Tamarit, D., Suarez, G., Scherpbier, H., ... Horban, A. (2005). Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clinical Infectious Diseases, 40(3), 458-465. https://doi.org/10.1086/427287

@article{d7661555a46d41c9a5cf3214b44fceed,

title = "Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy",

abstract = "Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions. Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during pregnancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis. Results. Receipt of antenatal antiretroviral therapy increased from 5% at the start of the HAART era to 92% in 2001-2003. The overall MTCT rate in this period was 2.87% (95% confidence interval [CI], 2.11%-3.81%), but it was 0.99% (95% CI, 0.32%-2.30%) during 2001-2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1; P = .003) and elective Caesarean section (AOR, 0.33; P = .04). Detection of maternal HIV RNA was significantly associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.03-0.33), compared with vaginal delivery or emergency Caesarean section. Conclusions. Our results suggest that offering an elective Caesarean section delivery to all HIV-infected women, even in areas where HAART is available, is appropriate clinical management, especially for persons with detectable viral loads. Our results also suggest that previously identified risk factors remain important.",

author = "Claire Thorne and C. Giaquinto and E. Ruga and {De Rossi}, A. and I. Grosch-Worner and J. Mok and {de Jose}, I. and I. Bates and F. Hawkins and {Ladron de Guevara}, C. and {Ma Pena}, J. and {Gonzalez Garcia}, J. and {Arribas Lopez}, {J. R.} and Garcia-Rodriguez, {M. C.} and F. Asensi-Botet and Otero, {M. C.} and D. Perez-Tamarit and G. Suarez and H. Scherpbier and M. Kreyenbroek and K. Boer and Bohlin, {A. B.} and S. Lindgren and A. Ehrnst and E. Belfrage and L. Naver and K. Lidman and B. Anzen and J. Levy and P. Barlow and M. Hainaut and A. Peltier and T. Goetghebuer and A. Ferrazin and D. Bassetti and {De Maria}, A. and C. Gotta and A. Mur and A. Paya and M. Vinolas and Lopez-Vilchez, {M. A.} and Rovira and R. Carreras and Valerius, {N. H.} and J. Jimenez and O. Coll and A. Suy and Perez, {J. M.} and C. Fortuny and {Casellas Caro}, M. and Y. Canet and V. Savasi and A. Vigano and E. Ferrazi and S. Alberico and M. Rabusin and M. Bernardon and Taylor, {G. P.} and Lyall, {E. G.H.} and Z. Penn and W. Buffolano and R. Tiseo and P. Martinelli and A. Agangi and Sansone, {C. M.} and C. Tibaldi and S. Marini and G. Masuelli and C. Benedetto and T. Niemiec and M. Marczynska and A. Horban",

year = "2005",

month = feb,

day = "1",

doi = "10.1086/427287",

language = "English",

volume = "40",

pages = "458--465",

number = "3",

}

Thorne, C, Giaquinto, C, Ruga, E, De Rossi, A, Grosch-Worner, I, Mok, J, de Jose, I, Bates, I, Hawkins, F, Ladron de Guevara, C, Ma Pena, J, Gonzalez Garcia, J, Arribas Lopez, JR, Garcia-Rodriguez, MC, Asensi-Botet, F, Otero, MC, Perez-Tamarit, D, Suarez, G, Scherpbier, H, Kreyenbroek, M, Boer, K, Bohlin, AB, Lindgren, S, Ehrnst, A, Belfrage, E, Naver, L, Lidman, K, Anzen, B, Levy, J, Barlow, P, Hainaut, M, Peltier, A, Goetghebuer, T, Ferrazin, A, Bassetti, D, De Maria, A, Gotta, C, Mur, A, Paya, A, Vinolas, M, Lopez-Vilchez, MA, Rovira, , Carreras, R, Valerius, NH, Jimenez, J, Coll, O, Suy, A, Perez, JM, Fortuny, C, Casellas Caro, M, Canet, Y, Savasi, V, Vigano, A, Ferrazi, E, Alberico, S, Rabusin, M, Bernardon, M, Taylor, GP, Lyall, EGH, Penn, Z, Buffolano, W, Tiseo, R, Martinelli, P, Agangi, A, Sansone, CM, Tibaldi, C, Marini, S, Masuelli, G, Benedetto, C, Niemiec, T, Marczynska, M & Horban, A 2005, 'Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy', Clinical Infectious Diseases, vol. 40, no. 3, pp. 458-465. https://doi.org/10.1086/427287

TY - JOUR

T1 - Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy

AU - Thorne, Claire

AU - Giaquinto, C.

AU - Ruga, E.

AU - De Rossi, A.

AU - Grosch-Worner, I.

AU - Mok, J.

AU - de Jose, I.

AU - Bates, I.

AU - Hawkins, F.

AU - Ladron de Guevara, C.

AU - Ma Pena, J.

AU - Gonzalez Garcia, J.

AU - Arribas Lopez, J. R.

AU - Garcia-Rodriguez, M. C.

AU - Asensi-Botet, F.

AU - Otero, M. C.

AU - Perez-Tamarit, D.

AU - Suarez, G.

AU - Scherpbier, H.

AU - Kreyenbroek, M.

AU - Boer, K.

AU - Bohlin, A. B.

AU - Lindgren, S.

AU - Ehrnst, A.

AU - Belfrage, E.

AU - Naver, L.

AU - Lidman, K.

AU - Anzen, B.

AU - Levy, J.

AU - Barlow, P.

AU - Hainaut, M.

AU - Peltier, A.

AU - Goetghebuer, T.

AU - Ferrazin, A.

AU - Bassetti, D.

AU - De Maria, A.

AU - Gotta, C.

AU - Mur, A.

AU - Paya, A.

AU - Vinolas, M.

AU - Lopez-Vilchez, M. A.

AU - Rovira, null

AU - Carreras, R.

AU - Valerius, N. H.

AU - Jimenez, J.

AU - Coll, O.

AU - Suy, A.

AU - Perez, J. M.

AU - Fortuny, C.

AU - Casellas Caro, M.

AU - Canet, Y.

AU - Savasi, V.

AU - Vigano, A.

AU - Ferrazi, E.

AU - Alberico, S.

AU - Rabusin, M.

AU - Bernardon, M.

AU - Taylor, G. P.

AU - Lyall, E. G.H.

AU - Penn, Z.

AU - Buffolano, W.

AU - Tiseo, R.

AU - Martinelli, P.

AU - Agangi, A.

AU - Sansone, C. M.

AU - Tibaldi, C.

AU - Marini, S.

AU - Masuelli, G.

AU - Benedetto, C.

AU - Niemiec, T.

AU - Marczynska, M.

AU - Horban, A.

PY - 2005/2/1

Y1 - 2005/2/1

N2 - Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions. Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during pregnancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis. Results. Receipt of antenatal antiretroviral therapy increased from 5% at the start of the HAART era to 92% in 2001-2003. The overall MTCT rate in this period was 2.87% (95% confidence interval [CI], 2.11%-3.81%), but it was 0.99% (95% CI, 0.32%-2.30%) during 2001-2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1; P = .003) and elective Caesarean section (AOR, 0.33; P = .04). Detection of maternal HIV RNA was significantly associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.03-0.33), compared with vaginal delivery or emergency Caesarean section. Conclusions. Our results suggest that offering an elective Caesarean section delivery to all HIV-infected women, even in areas where HAART is available, is appropriate clinical management, especially for persons with detectable viral loads. Our results also suggest that previously identified risk factors remain important.

AB - Background. Very low rates of mother-to-child transmission (MTCT) of human immunodeficiency virus (HIV) are achievable with use of highly active antiretroviral therapy (HAART). We examine risk factors for MTCT in the HAART era and describe infants who were vertically infected, despite exposure to prophylactic MTCT interventions. Methods. Of the 4525 mother-child pairs in this prospective cohort study, 1983 were enrolled during the period of January 1997 through May 2004. Factors examined included use of antiretroviral therapy during pregnancy, maternal CD4 cell count and HIV RNA level, mode of delivery, and gestational age in logistic regression analysis. Results. Receipt of antenatal antiretroviral therapy increased from 5% at the start of the HAART era to 92% in 2001-2003. The overall MTCT rate in this period was 2.87% (95% confidence interval [CI], 2.11%-3.81%), but it was 0.99% (95% CI, 0.32%-2.30%) during 2001-2003. In logistic regression analysis that included 885 mother-child pairs, MTCT risk was associated with high maternal viral load (adjusted odds ratio [AOR], 12.1; P = .003) and elective Caesarean section (AOR, 0.33; P = .04). Detection of maternal HIV RNA was significantly associated with antenatal use of antiretroviral therapy, CD4 cell count, and mode of delivery. Among 560 women with undetectable HIV RNA levels, elective Caesarean section was associated with a 90% reduction in MTCT risk (odds ratio, 0.10; 95% CI, 0.03-0.33), compared with vaginal delivery or emergency Caesarean section. Conclusions. Our results suggest that offering an elective Caesarean section delivery to all HIV-infected women, even in areas where HAART is available, is appropriate clinical management, especially for persons with detectable viral loads. Our results also suggest that previously identified risk factors remain important.

U2 - 10.1086/427287

DO - 10.1086/427287

M3 - Article

VL - 40

SP - 458

EP - 465

IS - 3

ER -

Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy

Abstract

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